Closed-loop / artificial pancreas systems

In people without diabetes, pancreatic islet cells detect glucose in the blood, and release insulin or glycogen to keep the glucose level in a safe range.

All people with type 1 diabetes use a treatment ‘loop’ to mimic this function the best we can – at present this involves:

  • a pump or insulin pen (for insulin delivery)
  • a blood glucose monitor and maybe CGM (for glucose level assessment), and
  • our brains and fingers to calculate the dose required and deliver it to complete the loop

‘Closing the loop’ means making it happen automatically. This means a calculator or ‘algorithm’ is needed to replace our brains and fingers. The glucose assessment is communicated to the algorithm, which then decides how much insulin is required and sends an instruction to a pump to deliver the dose. This is also called an artificial pancreas or closed-loop.

Research by JDRF has identified 6 key steps:

  1. an insulin pump with low glucose suspend when CGM detects hypoglycaemia
  2. predictive low glucose suspend when CGM detects glucose is falling towards hypoglycaemia
  3. predictive low & high glucose minimiser
  4. hybrid closed loop – basal rate is automated but meal-time boluses must be manually bolused
  5. fully automated closed loop with insulin only – needs no programming by the user
  6. fully automated closed loop with insulin and glucagon

Where are we now?

Step 1 was achieved with the Medtronic Veo and Enlite sensors. The Veo can be accessed by people who meet NICE criteria for insulin pump therapy. CGM is not yet routinely funded.

Step 3 is where unregulated, DIY artificial pancreas systems fit in – with a well-tuned basal rate they can help users spend more time within the optimal glucose range.

Step 4 is now available, with Medtronic 670G and Guardian 3 sensors. This is known as sensor-augmented pump therapy – or hybrid closed-loop.

(Step 5 is currently in limited in-home research trials here in the UK and around the world.)

Systems available in the UK:

Medtronic Veo + Enlite sensors with low glucose suspend
Medtronic 640G + Enlite or Guardian sensors with predictive low glucose suspend
Medtronic 670G + Guardian sensors with automated basal rate and predictive low & high glucose minimiser
Medtrum A6 + Medtrum sensor has predictive low glucose suspend
Coming to the UK soon! Tandem t:slim X2 has predictive low glucose suspend

Low glucose suspend will temporarily turn off the delivery of insulin if the sensor detects a hypo and the user does not respond to the alarms, for example if they are asleep.

Predictive low glucose suspend will temporarily turn off the delivery of insulin when the sensor detects that the glucose level is likely to dip into a hypo, therefore preventing the hypo from happening or minimising it’s severity.

Also in development

23 June 2015 Insulin Nation article about Bigfoot Biomedical

Bigfoot Biomedical

UK research

Imperial College Hospital b.iap (bio inspired artificial pancreas)

Addenbrooke’s Hospital, Cambridge (Dr Roman Hovorka) funded by JDRF

Nightscout #wearenotwaiting

Open source and open protocol approaches

Approaches instigated by people with type 1 to be able to better access and share data, particularly the blood glucose level data from continuous and flash glucose monitors.

Learn more