Closing the loop: combining insulin pumps and glucose sensors in children with type 1 diabetes mellitus
Shlomit Shalitin
Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Search for more papers by this authorCorresponding Author
Moshe Phillip
Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
*Moshe Phillip, MD, Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel. Tel: +972-3-9253731; fax: +972-3-9253836; e-mail: [email protected]Search for more papers by this authorShlomit Shalitin
Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Search for more papers by this authorCorresponding Author
Moshe Phillip
Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
*Moshe Phillip, MD, Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel. Tel: +972-3-9253731; fax: +972-3-9253836; e-mail: [email protected]Search for more papers by this authorAbstract
Abstract: Tight glycemic control of diabetic patients is associated with a reduction in the risk of microvascular and macrovascular complications, yet with elevated risk of severe episodes of hypoglycemia. The goal of “closing the loop” is to develop an autonomous insulin delivery system attached to a device capable of continuous glucose sensing, thus mimicking the islet beta cells activity and its capability of maintaining normal blood glucose levels and freeing the patient from the need of constant calculations of daily insulin and carbohydrates. The closed loop will protect patients from experiencing glucose excursions, including life-threatening events of hypoglycemia, thus improving glycemic control, reducing the fear from hypoglycemia and improving patients’ quality of life. This review focuses on the steps towards closing the loop in the attempts to develop an artificial pancreas and on recent ongoing research and future directions in this field.
References
- 1 Jaremko J, Rorstad O. Advances toward the implantable artificial pancreas for treatment of diabetes. Diabetes Care 1998: 7: 444–450.
- 2 Pfeiffer EF, Thum C, Clemens AH. The artificial beta cell- a continuous control of blood sugar by external regulation of insulin infusion (glucose controlled insulin infusion system). Horm Metab Res 1974: 6: 339–342.
- 3 Clemens AH, Chang PH, Myers RW. The development of Biostator, a glucose controlled insulin infusion system (GCIIS). Horm Metab Res Suppl 1977: 7: 23–33.
- 4 Albisser AM, Leibel BS, Ewrt TG, Davidovac Z, Botz CK, Zingg W. An artificial endocrine pancreas. Diabetes 1974: 23: 389–404.
- 5 Pickup JC, Keen H, Parsons JA, Alberti KGM. Continuous subcutaneous insulin infusion: an approach to achieving normoglycemia. Br Med J 1978: 1: 204–207.
- 6 Koivisto VA, Yki-Jarvinen H, Helve E, Karonen SL, Pelkonen R. Pathogenesis and prevention of the dawn phenomenon in diabetic patients treated with CSII. Diabetes 1986: 35: 78–82.
- 7 Renner R, Pfutzner A, Trautmann M, Harzer O, Sauter K, Landgraf R. Use of insulin lispro in continuous subcutaneous insulin infusion treatment. Results of a multicenter trial. German Humalog-CSII Study Group. Diabetes Care 1999: 22: 784–788.
- 8 Hanaire-Broutin H, Melki V, Bessieres-Lacombe S, Tauber JP. The Study Group for the Development of Pump Therapy in Diabetes. Comparison of continuous subcutaneous insulin infusion and multiple daily injection regimens using insulin lispro in type 1 diabetes patients on intensified treatment. Diabetes Care 2000: 23: 1232–1235.
- 9 Chantelau E, Spraul M, Muhlhauser I, Gause R, Berger M. Long-term safety, efficacy and side-effects of continuous subcutaneous insulin infusion treatment for type 1 diabetes mellitus: a one centre experience. Diabetologia 1989: 32: 421–426.
- 10 Mecklenburg RS, Benson EA, Benson JW et al. Acute complications associated with insulin infusion pump therapy. Report of experience with 161 patients. JAMA 1984: 252: 3265–3269.
- 11 Pietri A, Raskin P. Cutaneous complications of chronic continuous subcutaneous insulin infusion therapy. Diabetes Care 1981: 4: 624–626.
- 12 Schade DS, Valentine V. To pump or not to pump. Diabetes Care 2002: 25: 2100–2102.
- 13 Sekigami T, Shimoda S, Nishida K et al. Comparison between closed-loop portal and peripheral venous insulin delivery systems for an artificial pancreas. J Artif Organs 2004: 7: 91–100.
- 14 Schade DS, Eaton RP, Davis T et al. The kinetics of peritoneal insulin absorption. Metabolism 1981: 30: 149–155.
- 15 Selman JL, Charles MA. Devices for insulin administration. Diabetes Care 1990: 13: 955–979.
- 16 Buchwald J, Rohde TD. Implantable Insulin Pumps. Chicago: Year Book Medical Publishers, 1984: 177–222.
- 17 Irsigler K, Kritz H, Hagmuller G et al. Long-term continuous intraperitoneal insulin infusion with an implantable remote-controlled insulin infusion device. Diabetes 1981: 30: 1072–1075.
- 18 Saudek CD, Selman JL, Pitt HA et al. A preliminary trial of the programmable implantable medication system for insulin delivery. N Engl J Med 1989: 321: 574–579.
- 19 Broussolle C, Jeandidier N, Hanaire-Broutin H; Evadiac Study Group. French multicenter experience with implantable insulin pumps. Lancet 1994: 343: 514–515.
- 20 Gough DA, Armour JC, Baker DA. Advances and prospects in glucose assay technology. Diabetologia 1997: 40 (Suppl. 2): s49–s53.
- 21 Gough DA, Armour JC. Development of the implantable glucose sensor: what are the prospects and why is it taking so long? Diabetes 1995: 44: 1005–1009.
- 22 Potts RO, Tamada JA, Tierney MJ. Glucose monitoring by reverse iontophoresis. Diabetes Metab Res Rev 2002: 18 (Suppl. 1): s49–s53.
- 23 Chase HP, Beck R, Tamborlane W et al. A randomized multicenter trial comaring the GlucoWatch Biographer with standard glucose monitoring in children with type 1 diabetes. Diabetes Care 2005: 28: 1101–1106.
- 24 Mastrototaro JJ. The MiniMed continuous glucose monitoring system. Diabetes Technol Ther 2000: 2 (Suppl. 1): s13–s18.
- 25 Weintrob N, Schechter A, Benzaquen H et al. Glycemic patterns detected by continuous subcutaneous glucose sensing in children and adolescents with type 1 diabetes mellitus treated by multiple daily injections vs continuous subcutaneous insulin infusion. Arch Pediatr Adolesc Med 2004: 158: 677–684.
- 26 Maran A, Crepaldi C, Tiengo A et al. Continuous subcutaneous glucose monitoring in diabetic patients: a multicenter analysis. Diabetes Care 2002: 25: 347–352.
- 27 Updike SJ, Shults MC, Gilligan BJ, Rhodes RK. A subcutaneous glucose sensor with improved longevity, dynamic range, and stability of calibration. Diabetes Care 2000: 23: 208–214.
- 28 Armour JC, Lucisano JY, McKean BD, Gough DA. Application of chronic intravascular glucose sensor in dogs. Diabetes 1990: 39: 1519–1526.
- 29 Renard E. Implantable closed-loop glucose-sensing and insulin delivery: the future for insulin pump therapy. Curr Opin Pharmacol 2002: 2: 708–716.
- 30 Heptulla RA, Rodriguez LM, Bomgaars L, Haymond MW. The role of amylin and glucagon in the dampening of glycemic excursions in children with type 1 diabetes. Diabetes 2005: 54: 1100–1107.
- 31 Brunetti P, Cobelli C, Crucian P et al. A simulation study on a self-tuning portable controller of blood glucose. Int J Artif Organs 1993: 16: 51–57.
- 32 Renard E, Shah R, Miller M, Kolopp M, Costalat G, Bringer J. Sustained safety and accuracy of central IV glucose sensors connected to implanted insulin pumps and short-term closed-loop trials in diabetic patients. Diabetes 2003: 52 (Suppl. 2): 155.
- 33 Hovorka R, Chassin LJ, Wilinska ME. Closing the loop: the ADICOL experience. Diabetes Technol Ther 2004: 6: 307–318.
- 34 Wojcicki JM, Ladyzynski P. Toward the improvement of diabetes treatment: recent developments in technical support. J Artif Organs 2003: 6: 73–87.
- 35 Bolinder J, Deiss D, Riverline JP et al. Guardian® RT Continuous Glucose Monitoring System with real time glucose values and alarm functions: a new tool for improving glucose control in patients with type 1 diabetes mellitus. Diabetologia 2005: 48 (S1): Abstract 124.
