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  • Review Article
  • Published:

Closed-loop insulin delivery: from bench to clinical practice

Nature Reviews Endocrinology volume 7, pages 385–395 (2011)Cite this article

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Abstract

Automated closed-loop insulin delivery, also referred to as the 'artificial pancreas', has been an important but elusive goal of diabetes treatment for many decades. Research milestones include the conception of continuous glucose monitoring in the early 1960s, followed by the production of the first commercial hospital-based artificial pancreas in the late 1970s that combined intravenous glucose sensing and insulin delivery. In the past 10 years, research into the artificial pancreas has gained substantial momentum and focused on the subcutaneous route for glucose measurement and insulin delivery, which reflects technological advances in interstitial glucose monitoring and the increasing use of the continuous subcutaneous insulin infusion. This Review discusses the design of an artificial pancreas, its components and clinical results, as well as the advantages and disadvantages of different types of automated closed-loop systems and potential future advances. The introduction of the artificial pancreas into clinical practice will probably occur gradually, starting with simpler approaches, such as overnight control of blood glucose concentration and temporary pump shut-off, that are adapted to more complex situations, such as glycemic control during meals and exercise.

Key Points

  • Closed-loop systems deliver insulin according to real-time glucose levels

  • Closed-loop systems combine three components: a continuous glucose sensor, an insulin pump and a control algorithm

  • The subcutaneous route for glucose sensing and insulin delivery is most promising for widespread clinical use

  • Compared with conventional pump therapy, closed-loop insulin delivery under supervised conditions reduced the frequency of hypoglycemia and increased the time within the target glucose range

  • Introduction into clinical practice may be gradual, beginning with simpler approaches, such as overnight control and temporary pump shut-off, that progress to more complex situations, such as control during meals and exercise

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Figure 1: An illustrative depiction of a closed-loop insulin delivery system.

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Acknowledgements

R. Hovorka is supported by grants from the Juvenile Diabetes Research Foundation (#22-2006-1113, #22-2007-1801, #22-2009-801), Diabetes UK (BDA07/0003549, BDA07/0003551), European Commission Framework Program 7 (247138), the NIH (DK085621) and the NIHR Cambridge Biomedical Research Centre.

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  1. Institute of Metabolic Science, University of Cambridge, Box 289, Addenbrooke's Hospital, Hills Road, CB2 0QQ, Cambridge, UK

    Roman Hovorka

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The author declares associations with the following companies/organizations: Abbott Diabetes Care (grant/research support), Animas (grant/research support, consultant, speaker), Lifescan (speaker), Medtronic (speaker), University of Cambridge (patent holder).

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Hovorka, R. Closed-loop insulin delivery: from bench to clinical practice. Nat Rev Endocrinol 7, 385–395 (2011). https://doi.org/10.1038/nrendo.2011.32

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