Release of the artificial pancreas

Medtronic released its MiniMed 670G automated insulin delivery pump in 2017, a major step toward a fully automated insulin delivery system (also known as the artificial pancreas), for type 1 diabetes patients. “This is the first commercially available device to use continuous glucose monitoring information to adjust insulin doses,” Carlson says. “Using an algorithm inside the insulin pump, the system adjusts insulin doses up or down accordingly to target a healthy glucose level.”

Data show improved average diabetes control, more time spent in a more ideal blood glucose range, and fewer blood glucose readings in the low range. “This is important because both high and low glucoses are associated with significant complications and costs,” Carlson says. Hypoglycemia hospital admissions from the emergency department, for instance, cost an average of $1.2 billion per year, so any technology that prevents levels from going too low is a major advancement.

Carlson says the next step would be to create a fully “closed loop” device, rather than a “hybrid closed loop” device, that is smart enough to give a quick burst of insulin when the patient eats without having to tell the device that they are going to eat something. Currently, patients must enter their blood glucose and amount of carbohydrates they estimate are in a meal. Then, based on programed settings, the pump delivers an appropriate burst of insulin. To close the loop, the device would need to be able to handle that rapid increase in blood glucose following a meal or snack. Several groups are working on this, and newer systems may involve other hormones in addition to insulin being placed in the insulin pump.

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.