Top

29-08-2018 | Insulin pumps | Review | Article

Advances in Closed-Loop Insulin Delivery Systems in Patients with Type 1 Diabetes

Journal: Current Diabetes Reports

Authors: Vikash Dadlani, Jordan E. Pinsker, Eyal Dassau, Yogish C. Kudva

Abstract

Purpose of Review

To provide a current review of closed-loop insulin delivery or artificial pancreas (AP) as therapy for people with type 1 diabetes mellitus (T1D)

Recent Findings

The Medtronic Minimed 670G AP system has been in use in clinical practice since March 2017. Currently, Medtronic is conducting a large randomized clinical trial to evaluate its efficacy further in T1D. Simultaneously, the NIH has funded four research consortia to accelerate progress to approval of other AP and decision support systems. Several research groups are currently developing next-generation AP systems, with a number of companies moving toward releasing closed-loop systems in the future. AP systems are also being tested in select populations such as hypoglycemia-unaware T1D and pregnant T1D.

Summary

AP research is rapidly advancing. The clinical range of AP will be expanded in the next decade.

Eisenbarth GS. Type 1 diabetes mellitus. A chronic autoimmune disease. N Engl J Med. 1986;314(21):1360–8. https://doi.org/10.1056/nejm198605223142106.CrossRefPubMed

The Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86. https://doi.org/10.1056/nejm199309303291401.CrossRef

The Diabetes Control and Complications Trial Research Group. Hypoglycemia in the diabetes control and complications trial. Diabetes. 1997;46(2):271–86.CrossRef

Cryer PE. The barrier of hypoglycemia in diabetes. Diabetes. 2008;57(12):3169–76. https://doi.org/10.2337/db08-1084.CrossRefPubMedPubMedCentral

• Doyle FJ III, Huyett LM, Lee JB, Zisser HC, Dassau E. Closed-loop artificial pancreas systems: engineering the algorithms. Diabetes Care. 2014;37(5):1191–7. https://doi.org/10.2337/dc13-2108. Excellent review on engineering for the clinician. CrossRefPubMedPubMedCentral

• Kudva YC, Carter RE, Cobelli C, Basu R, Basu A. Closed-loop artificial pancreas systems: physiological input to enhance next-generation devices. Diabetes Care. 2014;37(5):1184–90. https://doi.org/10.2337/dc13-2066. Provides physiology background and studies needed for engineering future algorithms. CrossRefPubMedPubMedCentral

Cefalu WT, Tamborlane WV. The artificial pancreas: are we there yet? Diabetes Care. 2014;37(5):1182–3. https://doi.org/10.2337/dc14-0491.CrossRefPubMedPubMedCentral

US Food and Drug Adminsitration. FDA’s efforts to advance artificial pancreas device systems. 2018. https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/ArtificialPancreas/default.htm. Accessed 06/08/2018.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Collaborative efforts key to catalyzing creation of an artificial pancreas. 2014. https://www.niddk.nih.gov/news/archive/2014/collaborative-efforts-key-catalyzing-creation-artificial-pancreas. Accessed 06/15/2018.

10.

Sanchez RM. The critical path from pump to pancreas: the impact of FDA regulation on the development of a closed-loop diabetes management system. Food Drug Law J. 2013;68(1):53–76.PubMed

11.

• Bergenstal RM, Garg S, Weinzimer SA, Buckingham BA, Bode BW, Tamborlane WV, et al. Safety of a hybrid closed-loop insulin delivery system in patients with type 1 diabetes. JAMA. 2016;316(13):1407–8. https://doi.org/10.1001/jama.2016.11708. Results from the safety study that led to approval of 670 G system. CrossRefPubMed

12.

•• Garg SK, Weinzimer SA, Tamborlane WV, Buckingham BA, Bode BW, Bailey TS, et al. Glucose outcomes with the in-home use of a hybrid closed-loop insulin delivery system in adolescents and adults with type 1 diabetes. Diabetes Technol Ther. 2017;19(3):155–63. https://doi.org/10.1089/dia.2016.0421. Patient important glucose control results from the 670 G safety study. CrossRefPubMedPubMedCentral

13.

Weisman A, Bai JW, Cardinez M, Kramer CK, Perkins BA. Effect of artificial pancreas systems on glycaemic control in patients with type 1 diabetes: a systematic review and meta-analysis of outpatient randomised controlled trials. Lancet Diabetes Endocrinol. 2017;5(7):501–12. https://doi.org/10.1016/s2213-8587(17)30167-5.CrossRefPubMed

14.

• Peters TM, Haidar A. Dual-hormone artificial pancreas: benefits and limitations compared with single-hormone systems. Diabet Med. 2018;35(4):450–9. https://doi.org/10.1111/dme.13581. Review article on dual hormone systems for AP. CrossRefPubMed

15.

Bekiari E, Kitsios K, Thabit H, Tauschmann M, Athanasiadou E, Karagiannis T, et al. Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis. BMJ. 2018;361:k1310. https://doi.org/10.1136/bmj.k1310.CrossRefPubMedPubMedCentral

16.

Dai X, Luo ZC, Zhai L, Zhao WP, Huang F. Artificial pancreas as an effective and safe alternative in patients with type 1 diabetes mellitus: a systematic review and meta-analysis. Diabetes Ther. 2018;9:1269–77. https://doi.org/10.1007/s13300-018-0436-y.CrossRefPubMedPubMedCentral

17.

• Maahs DM, Buckingham BA, Castle JR, Cinar A, Damiano ER, Dassau E, et al. Outcome measures for artificial pancreas clinical trials: a consensus report. Diabetes Care. 2016;39(7):1175–9. https://doi.org/10.2337/dc15-2716. Consensus statement recommending uniform results reporting for AP studies. CrossRefPubMedPubMedCentral

18.

Agiostratidou G, Anhalt H, Ball D, Blonde L, Gourgari E, Harriman KN, et al. Standardizing clinically meaningful outcome measures beyond HbA1c for type 1 diabetes: a consensus report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange. Diabetes Care. 2017;40(12):1622–30. https://doi.org/10.2337/dc17-1624.CrossRefPubMedPubMedCentral

19.

Agrawal P, Stone M, Cordero T, Lee S, Shin J, Kaufman F. Real-world use of the Minimed 670G hybrid closed-loop system. Diabetes Technol Ther. 2018;20(S1):A-038.

20.

Forlenza GP, Li Z, Buckingham BA, Pinsker JE, Cengiz E, Wadwa R, et al. Predictive low glucose suspend reduces hypoglycemia in adults, adolescents, and children with type 1 diabetes in an at-home randomized crossover study: results of the PROLOG Trial. Diabetes Care. 2018; In Press

21.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Four pivotal NIH-funded artificial pancreas research efforts begin. 2017. https://www.nih.gov/news-events/news-releases/four-pivotal-nih-funded-artificial-pancreas-research-efforts-begin. Accessed 6/12/2018.

22.

Senseonics Investor Relations. Senseonics leads development efforts of a long-term “artificial pancreas” system for use in the International Diabetes Closed Loop Trial. 2017. http://www.senseonics.com/investor-relations/news-releases/2017/07-24-2017-213021126. Accessed 06/11/2018.

23.

Dassau E. Adaptive automated control of diabetes. American Diabetes Association 78th Scientific Sessions. Orlando, FL. 2018.

24.

Sherwood J, Balliro CA, Jafri RZ, El-Khatib F, Maheno M, Hillard MA, et al. Differential effects of the insulin-only and bihormonal configurations of the bionic pancreas on mean glucose and hypoglycemia during the daytime and nighttime. Diabetes. 2018;67(Supplement 1):299-OR. https://doi.org/10.2337/db18-299-OR.CrossRef

25.

Weinstock RS, Xing D, Maahs DM, Michels A, Rickels MR, Peters AL, et al. Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D exchange clinic registry. J Clin Endocrinol Metab. 2013;98(8):3411–9. https://doi.org/10.1210/jc.2013-1589.CrossRefPubMed

26.

Abitbol A, Rabasa-Lhoret R, Messier V, Legault L, Smaoui M, Cohen N, et al. Overnight glucose control with dual- and single-hormone artificial pancreas in type 1 diabetes with hypoglycemia unawareness: a randomized controlled trial. Diabetes Technol Ther. 2018;20(3):189–96. https://doi.org/10.1089/dia.2017.0353.CrossRefPubMed

27.

Murphy HR, Bell R, Cartwright C, Curnow P, Maresh M, Morgan M, et al. Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: a prospective nationwide study. Diabetologia. 2017;60(9):1668–77. https://doi.org/10.1007/s00125-017-4314-3.CrossRefPubMedPubMedCentral

28.

Macintosh MC, Fleming KM, Bailey JA, Doyle P, Modder J, Acolet D, et al. Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ. 2006;333(7560):177. https://doi.org/10.1136/bmj.38856.692986.AE.CrossRefPubMedPubMedCentral

29.

Jensen DM, Damm P, Moelsted-Pedersen L, Ovesen P, Westergaard JG, Moeller M, et al. Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study. Diabetes Care. 2004;27(12):2819–23.CrossRefPubMed

30.

Evers IM, de Valk HW, Visser GH. Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. BMJ. 2004;328(7445):915. https://doi.org/10.1136/bmj.38043.583160.EE.CrossRefPubMedPubMedCentral

31.

Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: a large, population-based study. Diabetes Care. 2009;32(11):2005–9. https://doi.org/10.2337/dc09-0656.CrossRefPubMedPubMedCentral

32.

• Stewart ZA, Wilinska ME, Hartnell S, Temple RC, Rayman G, Stanley KP, et al. Closed-loop insulin delivery during pregnancy in women with type 1 diabetes. N Engl J Med. 2016;375(7):644–54. https://doi.org/10.1056/NEJMoa1602494. First report of outpatient AP for pregnancy in T1D. CrossRefPubMed

33.

• Stewart ZA, Wilinska ME, Hartnell S, O'Neil LK, Rayman G, Scott EM, et al. Day-and-night closed-loop insulin delivery in a broad population of pregnant women with type 1 diabetes: a randomized controlled crossover trial. Diabetes Care. 2018. https://doi.org/10.2337/dc17-2534. RCT of outpatient AP for pregnancy in T1D at three medical centers. CrossRefPubMed

34.

Dadlani V, Tamhane SU, Sun A, Sharma A, Delivanis DA, Thapa P, et al. High glucose variability in hospitalized patients with type 1 diabetes mellitus. Diabetes Technol Ther. 2017;19(10):572–9. https://doi.org/10.1089/dia.2017.0107.CrossRefPubMedPubMedCentral

35.

• Thabit H, Hartnell S, Allen JM, Lake A, Wilinska ME, Ruan Y, et al. Closed-loop insulin delivery in inpatients with type 2 diabetes: a randomised, parallel-group trial. Lancet Diabetes Endocrinol. 2017;5(2):117–24. https://doi.org/10.1016/s2213-8587(16)30280-7. First report of inpatient AP for clinically hospitalized patients. CrossRefPubMed

36.

• Dassau E, Pinsker JE, Kudva YC, Brown SA, Gondhalekar R, Dalla Man C, et al. 12-Week 24/7 ambulatory artificial pancreas with weekly adaptation of insulin delivery settings: effect on hemoglobin A1c and hypoglycemia. Diabetes Care. 2017;40(12):1719–26. https://doi.org/10.2337/dc17-1188. First report of clinician-supervised weekly adaptive AP for 3 months. CrossRefPubMedPubMedCentral

37.

Kovatchev B, Cheng P, Anderson SM, Pinsker JE, Boscari F, Buckingham BA, et al. Feasibility of long-term closed-loop control: a multicenter 6-month trial of 24/7 automated insulin delivery. Diabetes Technol Ther. 2017;19(1):18–24. https://doi.org/10.1089/dia.2016.0333.CrossRefPubMed

38.

Anderson SM, Raghinaru D, Pinsker JE, Boscari F, Renard E, Buckingham BA, et al. Multinational home use of closed-loop control is safe and effective. Diabetes Care. 2016;39(7):1143–50. https://doi.org/10.2337/dc15-2468.CrossRefPubMedPubMedCentral

39.

Dassau E, Brown SA, Basu A, Pinsker JE, Kudva YC, Gondhalekar R, et al. Adjustment of open-loop settings to improve closed-loop results in type 1 diabetes: a multicenter randomized trial. J Clin Endocrinol Metab. 2015;100(10):3878–86. https://doi.org/10.1210/jc.2015-2081.CrossRefPubMedPubMedCentral

40.

• Thabit H, Tauschmann M, Allen JM, Leelarathna L, Hartnell S, Wilinska ME, et al. Home use of an artificial beta cell in type 1 diabetes. N Engl J Med. 2015;373(22):2129–40. https://doi.org/10.1056/NEJMoa1509351. RCT of outpatient AP for 3 months in adolescents and adults. CrossRefPubMedPubMedCentral

41.

• Russell SJ, El-Khatib FH, Sinha M, Magyar KL, McKeon K, Goergen LG, et al. Outpatient glycemic control with a bionic pancreas in type 1 diabetes. N Engl J Med. 2014;371(4):313–25. https://doi.org/10.1056/NEJMoa1314474. First substantive report of dual-hormone AP in the outpatient setting. CrossRefPubMedPubMedCentral

42.

Pinsker JE, Laguna Sanz AJ, Lee JB, Church M, Andre C, Lindsey LE, et al. Evaluation of an artificial pancreas with enhanced model predictive control (eMPC) and a glucose prediction trust index with unannounced exercise. Diabetes Technol Ther. 2018;20(7):455–64. https://doi.org/10.1089/dia.2018.0031.CrossRefPubMedPubMedCentral

43.

Brazeau AS, Mircescu H, Desjardins K, Dube MC, Weisnagel SJ, Lavoie C, et al. The Barriers to Physical Activity in Type 1 Diabetes (BAPAD-1) scale: predictive validity and reliability. Diabetes Metab. 2012;38(2):164–70. https://doi.org/10.1016/j.diabet.2011.10.005.CrossRefPubMed

44.

Dube MC, Valois P, Prud'homme D, Weisnagel SJ, Lavoie C. Physical activity barriers in diabetes: development and validation of a new scale. Diabetes Res Clin Pract. 2006;72(1):20–7. https://doi.org/10.1016/j.diabres.2005.08.008.CrossRefPubMed

45.

• Manohar C, Levine JA, Nandy DK, Saad A, Dalla Man C, McCrady-Spitzer SK, et al. The effect of walking on postprandial glycemic excursion in patients with type 1 diabetes and healthy people. Diabetes Care. 2012;35(12):2493–9. https://doi.org/10.2337/dc11-2381. Impact of non-exercise everyday physical activity on glucose control. CrossRefPubMedPubMedCentral

46.

Dasanayake IS, Bevier WC, Castorino K, Pinsker JE, Seborg DE, Doyle FJ III, et al. Early detection of physical activity for people with type 1 diabetes mellitus. J Diabetes Sci Technol. 2015;9(6):1236–45. https://doi.org/10.1177/1932296815592409.CrossRefPubMedPubMedCentral

47.

Krintz C, Wolski R, Pinsker JE, Dimopoulos S, Brevik J, Dassau E. On the use of consumer-grade activity monitoring devices to improve predictions of glycemic variability. Smart City 360°: First EAI International Summit. Revised Selected Papers: LNICST; 2016. p 166–78.CrossRef

48.

Dadlani V, Levine JA, McCrady-Spitzer SK, Dassau E, Kudva YC. Physical activity capture technology with potential for incorporation into closed-loop control for type 1 diabetes. J Diabetes Sci Technol. 2015;9(6):1208–16. https://doi.org/10.1177/1932296815609949.CrossRefPubMedPubMedCentral

49.

DeBoer MD, Cherñavvsky DR, Topchyan K, Kovatchev BP, Francis GL, Breton MD. Heart rate informed artificial pancreas system enhances glycemic control during exercise in adolescents with T1D. Pediatr Diabetes. 2016:n/a-n/a. https://doi.org/10.1111/pedi.12454.CrossRefPubMed

50.

• Breton MD, Chernavvsky DR, Forlenza GP, DeBoer MD, Robic J, Wadwa RP, et al. Closed-loop control during intense prolonged outdoor exercise in adolescents with type 1 diabetes: the Artificial Pancreas Ski Study. Diabetes Care. 2017;40(12):1644–50. https://doi.org/10.2337/dc17-0883. Effect of AP control on glucose status during skiing in young T1D. CrossRefPubMedPubMedCentral

51.

• Castle JR, El Youssef J, Wilson LM, Reddy R, Resalat N, Branigan D, et al. Randomized outpatient trial of single- and dual-hormone closed-loop systems that adapt to exercise using wearable sensors. Diabetes Care. 2018. https://doi.org/10.2337/dc18-0228. Comprehensive short duration outpatient study evaluating dual hormone control during exercise. CrossRefPubMedPubMedCentral

52.

Patel NS, Van Name MA, Cengiz E, Carria LR, Tichy EM, Weyman K, et al. Mitigating reductions in glucose during exercise on closed-loop insulin delivery: the Ex-Snacks Study. Diabetes Technol Ther. 2016;18(12):794–9. https://doi.org/10.1089/dia.2016.0311.CrossRefPubMedPubMedCentral

53.

Jacobs PG, El Youssef J, Reddy R, Resalat N, Branigan D, Condon J, et al. Randomized trial of a dual-hormone artificial pancreas with dosing adjustment during exercise compared with no adjustment and sensor-augmented pump therapy. Diabetes Obes Metab. 2016;18(11):1110–9. https://doi.org/10.1111/dom.12707.CrossRefPubMedPubMedCentral

54.

Jayawardene DC, McAuley SA, Horsburgh JC, Gerche A, Jenkins AJ, Ward GM, et al. Closed-loop insulin delivery for adults with type 1 diabetes undertaking high-intensity interval exercise versus moderate-intensity exercise: a randomized, crossover study. Diabetes Technol Ther. 2017;19(6):340–8. https://doi.org/10.1089/dia.2016.0461.CrossRefPubMed

55.

Taleb N, Emami A, Suppere C, Messier V, Legault L, Ladouceur M, et al. Efficacy of single-hormone and dual-hormone artificial pancreas during continuous and interval exercise in adult patients with type 1 diabetes: randomised controlled crossover trial. Diabetologia. 2016;59(12):2561–71. https://doi.org/10.1007/s00125-016-4107-0.CrossRefPubMed

56.

Huyett LM, Ly TT, Forlenza GP, Reuschel-DiVirgilio S, Messer LH, Wadwa RP, et al. Outpatient closed-loop control with unannounced moderate exercise in adolescents using zone model predictive control. Diabetes Technol Ther. 2017;19(6):331–9. https://doi.org/10.1089/dia.2016.0399.CrossRefPubMedPubMedCentral

57.

DeBoer MD, Chernavvsky DR, Topchyan K, Kovatchev BP, Francis GL, Breton MD. Heart rate informed artificial pancreas system enhances glycemic control during exercise in adolescents with T1D. Pediatr Diabetes. 2017;18(7):540–6. https://doi.org/10.1111/pedi.12454.CrossRefPubMed

58.

Kemmer FW, Bisping R, Steingruber HJ, Baar H, Hardtmann F, Schlaghecke R, et al. Psychological stress and metabolic control in patients with type I diabetes mellitus. N Engl J Med. 1986;314(17):1078–84. https://doi.org/10.1056/nejm198604243141704.CrossRefPubMed

59.

Moberg E, Kollind M, Lins PE, Adamson U. Acute mental stress impairs insulin sensitivity in IDDM patients. Diabetologia. 1994;37(3):247–51.CrossRefPubMed

60.

Wiesli P, Schmid C, Kerwer O, Nigg-Koch C, Klaghofer R, Seifert B, et al. Acute psychological stress affects glucose concentrations in patients with type 1 diabetes following food intake but not in the fasting state. Diabetes Care. 2005;28(8):1910–5.CrossRefPubMed

61.

Taborsky GJ. The physiology of glucagon. J Diabetes Sci Technol. 2010;4(6):1338–44. https://doi.org/10.1177/193229681000400607.CrossRefPubMedPubMedCentral

62.

El-Khatib FH, Balliro C, Hillard MA, Magyar KL, Ekhlaspour L, Sinha M, et al. Home use of a bihormonal bionic pancreas versus insulin pump therapy in adults with type 1 diabetes: a multicentre randomised crossover trial. Lancet. 2017;389(10067):369–80. https://doi.org/10.1016/s0140-6736(16)32567-3.CrossRefPubMed

63.

Russell SJ, Hillard MA, Balliro C, Magyar KL, Selagamsetty R, Sinha M, et al. Day and night glycaemic control with a bionic pancreas versus conventional insulin pump therapy in preadolescent children with type 1 diabetes: a randomised crossover trial. Lancet Diabetes Endocrinol. 2016;4(3):233–43. https://doi.org/10.1016/s2213-8587(15)00489-1.CrossRefPubMedPubMedCentral

64.

Haidar A, Legault L, Matteau-Pelletier L, Messier V, Dallaire M, Ladouceur M, et al. Outpatient overnight glucose control with dual-hormone artificial pancreas, single-hormone artificial pancreas, or conventional insulin pump therapy in children and adolescents with type 1 diabetes: an open-label, randomised controlled trial. Lancet Diabetes Endocrinol. 2015;3(8):595–604. https://doi.org/10.1016/s2213-8587(15)00141-2.CrossRefPubMed

65.

Beta Bionics Inc. Beta Bionics receives IDE approval from the FDA to begin a home-use clinical trial testing the new iLet Bionic Pancreas System. 2018. https://docs.wixstatic.com/ugd/6df851_711995f7e8684c6fb2bec5d1e733c5fe.pdf. Accessed 6/11/2018.

66.

Barnard K, Crabtree V, Adolfsson P, Davies M, Kerr D, Kraus A, et al. Impact of type 1 diabetes technology on family members/significant others of people with diabetes. J Diabetes Sci Technol. 2016;10(4):824–30. https://doi.org/10.1177/1932296816645365.CrossRefPubMedPubMedCentral

67.

Dassau E, Renard E, Place J, Farret A, Pelletier MJ, Lee J, et al. Intraperitoneal insulin delivery provides superior glycemic regulation to subcutaneous insulin delivery in model predictive control-based fully-automated artificial pancreas in patients with type 1 diabetes: a pilot study. Diabetes Obes Metab. 2017;19(12):1698–705. https://doi.org/10.1111/dom.12999.CrossRefPubMedPubMedCentral

68.

Weissberg-Benchell J, Hessler D, Polonsky WH, Fisher L. Psychosocial impact of the bionic pancreas during summer camp. J Diabetes Sci Technol. 2016;10(4):840–4. https://doi.org/10.1177/1932296816640289.CrossRefPubMedPubMedCentral

69.

Weissberg-Benchell J, Hood K, Laffel L, Heinemann L, Ball D, Kowalski A, et al. Toward development of psychosocial measures for automated insulin delivery. J Diabetes Sci Technol. 2016;10(3):799–801. https://doi.org/10.1177/1932296815619637.CrossRefPubMed

70.

Bangor A, Kortum P, Miller J. Determining what individual SUS scores mean: adding an adjective rating scale. J Usability Stud. 2009;4(3):114–23.

71.

Barnard KD, Wysocki T, Ully V, Mader JK, Pieber TR, Thabit H, et al. Closing the loop in adults, children and adolescents with suboptimally controlled type 1 diabetes under free living conditions: a psychosocial substudy. J Diabetes Sci Technol. 2017;11(6):1080–8. https://doi.org/10.1177/1932296817702656.CrossRefPubMedPubMedCentral

72.

Lewis D, Leibrand S. Real-world use of open source artificial pancreas systems. J Diabetes Sci Technol. 2016;10(6):1411. https://doi.org/10.1177/1932296816665635.CrossRefPubMedPubMedCentral

73.

JDRF. JDRF announces new initiative to pave way for open protocol automated insulin delivery systems. 2017. http://www.jdrf.org/press-releases/jdrf-announces-new-initiative-to-pave-way-for-open-protocol-automated-insulin-delivery-systems/. Accessed 6/12/2018.

74.

Desborough L, Naylor R, Block J, Buckingham BA, Pinsker JE, Wadwa P, et al. Leveraging modeling and simulation in the development of the bigfoot biomedical automated insulin delivery system. J Diabetes Sci Technol. 2018;12(2):A18.

75.

Buckingham BA, Forlenza GP, Pinsker JE, Christiansen MP, Wadwa RP, Schneider J, et al. Safety and feasibility of the OmniPod hybrid closed-loop system in adult, adolescent, and pediatric patients with type 1 diabetes using a personalized model predictive control algorithm. Diabetes Technol Ther. 2018;20(4):257–62. https://doi.org/10.1089/dia.2017.0346.CrossRefPubMedPubMedCentral

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform.

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »