Artificial Pancreas: A Concise Review

Sang Youl Rhee; Seoung Woo Han; Jeong-Taek Woo

doi:10.4093/jkd.2017.18.3.141

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Rhee, Han, and Woo: Artificial Pancreas: A Concise Review

Statement

J Korean Diabetes 2017;18(3):141-149.

Published online: 10 January 2017

DOI: https://doi.org/10.4093/jkd.2017.18.3.141

Artificial Pancreas: A Concise Review

Sang Youl Rhee, Seoung Woo Han, Jeong-Taek Woo

Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea

Corresponding author: Jeong-Taek Woo Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea, E-mail: jtwoomd@khmc.or.kr

Received 27 June 2017 Accepted 28 June 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Artificial pancreas is a technique developed to automatically control blood glucose in people with diabetes by providing an endocrine function instead of a healthy pancreas. The technique was developed for the replacement of insulin secretion deficiencies among various exocrine and endocrine functions of the pancreas and is mainly used for people with type 1 diabetes or those who need intensive insulin treatment. This review briefly summarizes the working principles, components, recent clinical research, and future perspectives of artificial pancreas.

Keywords: Artificial, Diabetes mellitus, Extracellular fluid, Glucose, Insulin, Pancreas

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Fig. 1.

General concept of the artificial pancreas technique.

Fig. 2.

The main components of the closed loop artificial pancreas system, and the three key technical limitations that need to be overcome.

Table 1.

Clinical trials of the latest ‘closed loop’ artificial pancreas performed since 2010. Most studies were performed with an open label, randomized design, and the control group was a conventional insulin pump treatment group

Study	Subjects	Baseline HbA1c (%)	Period	Intervention	Target glucose	Outcome
Bally et al. 2017 [23]	29 (T1DM)	6.9	4 wk	Close loop system (FlorenceD2A)	3.9∼10.0 mmol/L	10.5% higher (95% CI, 7.6∼13.4; P < 0.0001)
Stewart et al. 2016 [24]	16 (T1DM, pregnant)	6.8	4 wk	Close loop system (FlorenceD2W)	63∼140 mg/dL	15.2% higher (95% CI, 6.1∼24.2; P = 0.002)
Tauschmann et al. 2016 [25]	12 (T1DM, adolescents)	8.3	7 d	Close loop system (FlorenceD2A)	3.9∼10.0 mmol/L	19.0% higher (P < 0.001)
Reddy et al. 2015 [26]	12 (T1DM)	7.4	24 h	BiAP system	3.9∼10.0 mmol/L	No difference between closed-loop and open-loop (71% vs. 66.9%,P = 0.9)
Cherñavvsky et al. 2016 [27]	16 (T1DM, adolescents)	8.2	8 h	Close loop system (DiAs)	70∼180 mg/dL	24.0% higher (P < 0.001)
Thabit et al. 2015 [28]	33 (T1DM)	8.5	12 wk	Close loop system (FlorenceD2A)	70∼180 mg/dL	11.0% higher (95% CI, 8.1∼13.8; P < 0.001)
Kropff et al. 2015 [29]	32 (T1DM)	8.2	8 wk	Close loop system (DiAs)	3.9∼10.0 mmol/L	8.6% higher (95% CI, 5.8∼11.4; P < 0.0001)
Dassau et al. 2015 [30]	32 (T1DM)	7.5	27 h	–	70∼180 mg/dL	No difference between closed-loop and open-loop (39.7% vs. 44.2%)
Ly et al. 2015 [31]	20 (T1DM)	8.6	6 d	Close loop system (Medtronic MiniMed)	70∼180 mg/dL	No difference between closed-loop and open-loop (73.1% vs. 69.9%, P = 0.580)
Brown et al. 2015 [32]	10 (T1DM)	7.0	5 nights	Close loop system (DiAs)	80∼140 mg/dL, overnight (23:00∼07:00 h)	22.3% higher (54.5% vs. 32.2%;P < 0.001)
Thabit et al. 2015 [33]	40 (T1DM)	8.0	4 wk	Close loop system (FlorenceD2A)	3.9∼8.0 mmol/L	18.5% higher (P < 0.001), overnight
Nimri et al. 2014 [34]	24 (T1DM)	7.5	6 wk	MD-Logic system	Below 70 mg/dL (3.9 mmol/L), overnight	Significantly reduced time spent in hypoglycemia (P = 0.02)
Leelarathna et al. 2014 [35]	17 (T1DM)	7.6	7 d	Close loop system (Florence)	3.9∼10.0 mmol/L	13.0% higher (75.0% vs. 62.0%, P = 0.005)
Thabit et al. 2014 [36]	24 (T1DM)	8.1	4 wk	Close loop system (Florence)	3.9∼8.0 mmol/L between 0000 h and 0700 h	13.5% higher (95% CI, 7.3∼19.7; P = 0.0002)

HbA1c, hemoglobin A1c; T1DM, type 1 diabetes mellitus; CI, confidence interval; BiAP, bio-inspired artificial pancreas; DiAs, diabetes assistant

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