Intended for healthcare professionals


Closed loop control for type 1 diabetes

BMJ 2011; 342 doi: (Published 14 April 2011) Cite this as: BMJ 2011;342:d1911
  1. Boris Kovatchev, professor, University of Virginia
  1. 1Center for Diabetes Technology, Charlottesville, VA 22908, USA
  1. boris{at}

Shows promise in a research setting, but needs further development in practice

In the linked randomised crossover studies (doi:10.1136/bmj.d1855), Hovorka and colleagues compare the safety and efficacy of overnight closed loop insulin delivery with conventional insulin pumps in adults with type 1 diabetes.1 Automated closed loop control, known as an “artificial pancreas,” has the potential to greatly improve the health and lives of people with type 1 diabetes. The idea is not new—it can be traced back to developments that took place decades ago, when studies using intravenous glucose measurement and infusion of insulin and glucose showed that external blood glucose regulation was possible.2 3 Although these systems resulted in excellent glucose control, they were cumbersome and unsuitable for long term or outpatient use.4 5

With the advent of minimally invasive subcutaneous continuous glucose monitoring, research and drug company efforts have been focused on the development of subcutaneous artificial pancreas systems. These systems link a continuous glucose monitor and a subcutaneous insulin infusion pump via a control algorithm, which retrieves continuous glucose monitoring data in real time (for example, every five minutes) and uses a mathematical formula to compute insulin delivery rates that are then transmitted to the insulin pump.6 So far, several studies have reported encouraging results.7 8 9 10 Almost all of the studies reported that closed loop control was better than …

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