Can We Really Close the Loop and How Soon? Accelerating the Availability of an Artificial Pancreas: A Roadmap to Better Diabetes Outcomes

Development of a closed-loop artificial pancreas has been a long-time goal that could transform diabetes management. The primary limitation until recent years was the lack of a robust and portable continuous glucose sensor. There has been significant progress over the past 5 years in the development and commercialization of continuous glucose monitoring (CGM) devices. Used adjunctively, CGM has been demonstrated to add significant value in improving diabetes management by increasing time spent in glycemic targets and improving overall glycemic control. However, these benefits are limited by the human user's finite capacity to respond to the data provided by the device. By automating even a portion of the insulin delivery functionality of combined sensor/pump systems via computer algorithm, impending excursions could be handled more quickly and effectively. This review will describe very promising preliminary closed-loop studies, describe a potential roadmap to an artificial pancreas that will be safe and effective, and propose a solution-a hypo- and hyperglycemia minimizing control-to-range approach-that may allow for near-term delivery of a semiautomated system to people with diabetes.