Abstract
Improvements in accuracy of real-time continuous glucose monitoring facilitate the development of closed-loop systems consisting of a continuous glucose monitor, a control algorithm, and an insulin pump. Closedloop systems can be divided according to the way meal delivery is handled as “fully closed-loop” or “closed-loop” with meal announcement systems. Depending on the subcutaneous (sc) or intravenous (iv) body interface, three major types of closed-loop systems are recognised, (i) sc sensing and sc delivery system, (ii) the iv sensing and intraperitoneal delivery system, and (iii) the iv glucose sensing and iv insulin delivery system. Given the current research focus, this review centres on the sc-sc closed-loop approach, which has the greatest potential for a near-future commercial exploitation as recognised by the JDRF Artificial Pancreas Project. Other approaches utilising intraperitoneal or intravenous sensing/delivery are also discussed. Closed-loop systems may revolutionise diabetes management but their introduction is likely to be gradual starting from simpler applications such as hypoglycaemia prevention or overnight glucose control progressing to more complex approaches such as 24/7 glucose control. The most important question is what is achievable with existing technologies and when the first generation of closed-loop systems will find its way into clinical practice.
Keywords: Automated insulin delivery, Artificial pancreas, Insulin pump, Control algorithm, Model-predictive control, PID control, Type 1 diabetes
Current Diabetes Reviews
Title: The Future of Continuous Glucose Monitoring: Closed Loop
Volume: 4 Issue: 3
Author(s): Roman Hovorka
Affiliation:
Keywords: Automated insulin delivery, Artificial pancreas, Insulin pump, Control algorithm, Model-predictive control, PID control, Type 1 diabetes
Abstract: Improvements in accuracy of real-time continuous glucose monitoring facilitate the development of closed-loop systems consisting of a continuous glucose monitor, a control algorithm, and an insulin pump. Closedloop systems can be divided according to the way meal delivery is handled as “fully closed-loop” or “closed-loop” with meal announcement systems. Depending on the subcutaneous (sc) or intravenous (iv) body interface, three major types of closed-loop systems are recognised, (i) sc sensing and sc delivery system, (ii) the iv sensing and intraperitoneal delivery system, and (iii) the iv glucose sensing and iv insulin delivery system. Given the current research focus, this review centres on the sc-sc closed-loop approach, which has the greatest potential for a near-future commercial exploitation as recognised by the JDRF Artificial Pancreas Project. Other approaches utilising intraperitoneal or intravenous sensing/delivery are also discussed. Closed-loop systems may revolutionise diabetes management but their introduction is likely to be gradual starting from simpler applications such as hypoglycaemia prevention or overnight glucose control progressing to more complex approaches such as 24/7 glucose control. The most important question is what is achievable with existing technologies and when the first generation of closed-loop systems will find its way into clinical practice.
Export Options
About this article
Cite this article as:
Hovorka Roman, The Future of Continuous Glucose Monitoring: Closed Loop, Current Diabetes Reviews 2008; 4 (3) . https://dx.doi.org/10.2174/157339908785294479
DOI https://dx.doi.org/10.2174/157339908785294479 |
Print ISSN 1573-3998 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6417 |
Call for Papers in Thematic Issues
Advancing Diabetic Wound Healing: Mechanisms and Interventions
In recent years, diabetic wounds have become a global health concern with the increase in the incidence of diabetes. Diabetic wounds are a kind of chronic and refractory ulcer. It is generally due to the microcirculatory disturbances and the reduced levels of endogenous growth factors. Delayed cutaneous wound healing is ...read more
Oxidative and inflammatory responses in the development of secondary diabetic complications
Diabetes, along with its associated secondary complications, represents a significant global health challenge, contributing significantly to morbidity and mortality. Unhealthy lifestyle habits, reduced physical activity, environmental pollutants, and stress are pivotal factors in the onset of diabetes, particularly type-2 diabetes. Poorly managed hyperglycemia can lead to various complications, including neuropathy, ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Systemic Administration of Fluoro-Gold for the Histological Assessment of Vascular Structure, Integrity and Damage
Current Neurovascular Research Lipids, Statins and Heart Failure: An Update
Current Pharmaceutical Design A Review on Electrocardiographic Changes in Diabetic Patients
Current Diabetes Reviews Molecular Mechanisms Determining Opposed Functional States of Microglia
Current Neuropharmacology Role of Methylglyoxal in Diabetic Cardiovascular and Kidney Diseases: Insights from Basic Science for Application into Clinical Practice
Current Pharmaceutical Design Advances of Phenoxazines: Synthesis, Reactivity and Their Medicinal Applications
Current Medicinal Chemistry Angiogenic and Antiangiogenic Factors in Proliferative Diabetic Retinopathy
Current Diabetes Reviews Small Peptide and Protein-based Molecular Probes for Imaging Neurological Diseases
Current Protein & Peptide Science Neurological Disorders in Medical Use of <i>Cannabis</i>: An Update
CNS & Neurological Disorders - Drug Targets PiWi RNA in Neurodevelopment and Neurodegenerative Disorders
Current Molecular Pharmacology Effect of Antioxidants on Heavy Metals Induced Conformational Alteration of Cytochrome C and Myoglobin
Protein & Peptide Letters Histone Deacetylase 2 in the Mouse Hippocampus: Attenuation of Age- Related Increase by Caloric Restriction
Current Alzheimer Research Anti-cancer and Anti-angiogenic Properties of Various Natural Pentacyclic Tri-terpenoids and Some of their Chemical Derivatives
Current Organic Chemistry Antioxidants and its Properties as Affected by Extrusion Process: A Review
Recent Patents on Food, Nutrition & Agriculture Editorial (Thematic Issue: Molecular and Cellular Engineering Approaches for Neurological Disorders, Diseases, and Injuries Involved the Central and Peripheral Nervous Systems)
CNS & Neurological Disorders - Drug Targets Atorvastatin and Diabetic Vascular Complications
Current Pharmaceutical Design Evaluation of the Binding Affinity of a Gonadotropin-Releasing Hormone Analogue (GnRH-a) Buserelin through <i>In silico</i> and <i>In vivo</i> Testing in <i>Clarias magur</i>
Current Proteomics Antioxidants in the Practice of Medicine; What Should the Clinician Know?
Cardiovascular & Hematological Disorders-Drug Targets Minocycline: Neuroprotective Mechanisms in Parkinsons Disease
Current Pharmaceutical Design Fibrates and Statins in the Treatment of Diabetic Retinopathy
Current Pharmaceutical Biotechnology