The artificial pancreas: current status and future prospects in the management of diabetes

• Published in: Annals of the New York Academy of Sciences 2014-04, Vol.1311 (1), p.102-123
• Main Authors: Peyser, Thomas, Dassau, Eyal, Breton, Marc, Skyler, Jay S.
• Format: Article
• Language: English
• Subjects: Algorithms; artificial pancreas; Blood; continuous glucose monitoring; Control theory; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - surgery; Glucose; Humans; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - therapeutic use; insulin infusion; Insulin Infusion Systems; Mathematical models; Monitoring systems; Pancreas; Pancreas, Artificial; Safety; Smartphones
• ISSN: 0077-8923; 1749-6632
• DOI: 10.1111/nyas.12431

Recent advances in insulins, insulin pumps, continuous glucose‐monitoring systems, and control algorithms have resulted in an acceleration of progress in the development of artificial pancreas devices. This review discusses progress in the development of external systems that are based on subcutaneous drug delivery and subcutaneous continuous glucose monitoring. There are two major system‐level approaches to achieving closed‐loop control of blood glucose in diabetic individuals. The unihormonal approach uses insulin to reduce blood glucose and relies on complex safety mitigation algorithms to reduce the risk of hypoglycemia. The bihormonal approach uses both insulin to lower blood glucose and glucagon to raise blood glucose, and also relies on complex algorithms to provide for safety of the user. There are several major strategies for the design of control algorithms and supervision control for application to the artificial pancreas: proportional–integral–derivative, model predictive control, fuzzy logic, and safety supervision designs. Advances in artificial pancreas research in the first decade of this century were based on the ongoing computer revolution and miniaturization of electronic technology. The advent of modern smartphones has created the ability to utilize smartphone technology as the engineering centerpiece of an artificial pancreas. With these advances, an artificial or bionic pancreas is within reach.