REVIEW
Dual-hormone artificial pancreas for management of type 1 diabetes: Recent progress and future directions
Marco Infante,
David A. Baidal,
Michael R. Rickels,
Andrea Fabbri,
Jay S. Skyler,
Rodolfo Alejandro,
Camillo Ricordi,
Corresponding Author
Marco Infante
Clinical Cell Transplant Program, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Division of Endocrinology, Metabolism and Diabetes, Department of Systems Medicine, CTO A. Alesini Hospital, Diabetes Research Institute Federation, University of Rome Tor Vergata, Rome, Italy
UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
Correspondence
Marco Infante, UniCamillus, Saint Camillus International University of Health Sciences, Via di Sant’Alessandro 8, Rome 00131, Italy.
Email: [email protected]; [email protected]
Search for more papers by this authorDavid A. Baidal
Clinical Cell Transplant Program, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Search for more papers by this authorMichael R. Rickels
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Institute for Diabetes, Obesity and Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
Search for more papers by this authorAndrea Fabbri
Division of Endocrinology, Metabolism and Diabetes, Department of Systems Medicine, CTO A. Alesini Hospital, Diabetes Research Institute Federation, University of Rome Tor Vergata, Rome, Italy
Search for more papers by this authorJay S. Skyler
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Search for more papers by this authorRodolfo Alejandro
Clinical Cell Transplant Program, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Search for more papers by this authorCamillo Ricordi
Clinical Cell Transplant Program, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Search for more papers by this authorMarco Infante,
David A. Baidal,
Michael R. Rickels,
Andrea Fabbri,
Jay S. Skyler,
Rodolfo Alejandro,
Camillo Ricordi,
Corresponding Author
Marco Infante
Clinical Cell Transplant Program, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Division of Endocrinology, Metabolism and Diabetes, Department of Systems Medicine, CTO A. Alesini Hospital, Diabetes Research Institute Federation, University of Rome Tor Vergata, Rome, Italy
UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
Correspondence
Marco Infante, UniCamillus, Saint Camillus International University of Health Sciences, Via di Sant’Alessandro 8, Rome 00131, Italy.
Email: [email protected]; [email protected]
Search for more papers by this authorDavid A. Baidal
Clinical Cell Transplant Program, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Search for more papers by this authorMichael R. Rickels
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Institute for Diabetes, Obesity and Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
Search for more papers by this authorAndrea Fabbri
Division of Endocrinology, Metabolism and Diabetes, Department of Systems Medicine, CTO A. Alesini Hospital, Diabetes Research Institute Federation, University of Rome Tor Vergata, Rome, Italy
Search for more papers by this authorJay S. Skyler
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Search for more papers by this authorRodolfo Alejandro
Clinical Cell Transplant Program, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Search for more papers by this authorCamillo Ricordi
Clinical Cell Transplant Program, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Search for more papers by this authorAbstract
Over the last few years, technological advances have led to tremendous improvement in the management of type 1 diabetes (T1D). Artificial pancreas systems have been shown to improve glucose control compared with conventional insulin pump therapy. However, clinically significant hypoglycemic and hyperglycemic episodes still occur with the artificial pancreas. Postprandial glucose excursions and exercise-induced hypoglycemia represent major hurdles in improving glucose control and glucose variability in many patients with T1D. In this regard, dual-hormone artificial pancreas systems delivering other hormones in addition to insulin (glucagon or amylin) may better reproduce the physiology of the endocrine pancreas and have been suggested as an alternative tool to overcome these limitations in clinical practice. In addition, novel ultra-rapid-acting insulin analogs with a more physiological time–action profile are currently under investigation for use in artificial pancreas devices, aiming to address the unmet need for further improvements in postprandial glucose control. This review article aims to discuss the current progress and future outlook in the development of novel ultra-rapid insulin analogs and dual-hormone closed-loop systems, which offer the next steps to fully closing the loop in the artificial pancreas.
CONFLICT OF INTEREST
Michael R. Rickels reports research support from Xeris Pharmaceuticals. Jay S. Skyler acknowledges being on the Board of Directors of Dexcom, Inc., and receiving payment for service. The remaining authors declare no competing interests.
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