ABSTRACT:
Steady progress is being made toward the development of a so-called ‘‘artificial pancreas,’’ which may ultimatelybe a fully automated, closed-loop, glucose control system comprising a continuous glucose monitor, an insulinpump, and a controller. The controller will use individualized algorithms to direct delivery of insulin withoutuser input. A major factor propelling artificial pancreas development is the substantial incidence of—and attendant patient, parental, and physician concerns about—hypoglycemia and extreme hyperglycemia associatedwith current means of insulin delivery for type 1 diabetes mellitus (T1DM). A successful fully automatedartificial pancreas would likely reduce the frequency of and anxiety about hypoglycemia and marked hyperglycemia. Patch-pump systems (‘‘patch pumps’’) are likely to be used increasingly in the control of T1DM andmay be incorporated into the artificial pancreas systems of tomorrow. Patch pumps are free of tubing, small, lightweight, and unobtrusive. This article describes features of patch pumps that have been approved for U.S.marketing or are under development. Included in the review is an introduction to control algorithms drivinginsulin delivery, particularly the two major types: proportional integrative derivative and model predictivecontrol. The use of advanced algorithms in the clinical development of closed-loop systems is reviewed alongwith projected next steps in artificial pancreas development.