What is the role of artificial pancreases in the treatment of type 1 diabetes mellitus (DM)?

Updated: Oct 08, 2021
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

Closed-loop systems, also known as artificial pancreases, are in development for use in improving glycemic control in type 1 diabetes. These systems include a CGM that is in constant communication with an infusion pump, with a blood glucose device (eg, a glucose meter) utilized for CGM calibration. An external processor, such as a cell phone, runs control algorithm software, receiving data from the CGM. The data is used to perform a series of calculations, producing dosing instructions that are sent to the infusion pump. [129]

The artificial pancreases are being developed to administer either insulin or glucagon or a combination of the two agents. [130] A 1-month study in 20 patients indicated that, with regard to keeping blood glucose levels in the target range over a 24-hour period, round-the-clock use of closed-loop glucose control is more effective than use of a patient-controlled sensor-augmented pump. [131, 132]

In September 2016, the FDA approved the first artificial pancreas, Medtronic's MiniMed 670G, for persons aged 14 years or older with type 1 diabetes. A hybrid closed-loop system, it still requires patients to determine the number of carbohydrates in their food and input that data into the system, manually requesting the insulin dose needed for meals. [135]  In June 2018, the FDA extended the MiniMed 670G’s approval to children aged 7-13 years with type 1 diabetes. [136]

In 2020, the FDA approved Medtronic’s MiniMed 770G, a Bluetooth-enabled, hybrid closed-loop device, for use in children aged 2-6 years. [133] Another hybrid closed-loop system, Control-IQ, from Tandem Diabetes Care, was approved in 2019, and, according to the FDA, “is the first such controller that can be used with other diabetes devices that are also designed to be integrated into a customizable diabetes management system for automated insulin delivery.” [134]


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