Is an artificial pancreas (closed-loop system) for Type 1 diabetes effective?
Accepted version
Repository URI
Repository DOI
Change log
Authors
Abstract
The artificial pancreas is now a viable treatment option for people with Type 1 diabetes and has demonstrated improved glycaemic outcomes while also reducing the onus of self-management of Type 1 diabetes. Closed-loop glucose-responsive insulin delivery guided by real-time sensor glucose readings can accommodate highly variable day-to-day insulin requirements and reduce the hypoglycaemia risk observed with tight glycaemic control in Type 1 diabetes. In 2011, the James Lind Alliance research priorities for Type 1 diabetes were produced and priority 3 was to establish whether an artificial pancreas (closed-loop system) for Type 1 diabetes is effective. This review focuses on the progress that has been made in the evolution of closed-loop systems as an effective treatment option for Type 1 diabetes. Development of closed-loop systems has advanced from feasibility evaluations in highly supervised settings over short periods, to clinical studies in free-living, unsupervised conditions lasting several months. The approval in the USA of the first hybrid closed-loop system (MiniMed® 670G pump, Medtronic, Northridge, CA, USA) in 2016 for use in Type 1 diabetes reflects these advancements. We discuss the evidence from clinical studies that closed-loop systems are effective with improved glycaemic outcomes, reduced hypoglycaemia and had positive end-user acceptance in children, adolescents, adults and pregnant women with Type 1 diabetes. We also present the outlook for future closed-loop systems in the treatment of Type 1 diabetes and identify the challenges facing the wide-spread clinical adoption of this technology.
Description
Keywords
Journal Title
Conference Name
Journal ISSN
1464-5491
Volume Title
Publisher
Publisher DOI
Sponsorship
Juvenile Diabetes Research Foundation Ltd (JDRF) (2-SRA-2014-256-M-R)
European Commission Horizon 2020 (H2020) Societal Challenges (731560)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Department of Health (via National Institute for Health Research (NIHR)) (EME 14/23/09)
National Institute of Diabetes and Digestive and Kidney Diseases (UC4DK108520)
National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK112176)
NIHR Evaluation Trials and Studies Coordinating Centre (14/23/09)