Closed-loop artificial pancreas creeps closer to reality
EXPERT ANALYSIS FROM THE ADA ADVANCED POSTGRADUATE COURSE
Researchers are also investigating whether the addition of pramlintide to insulin could improve the performance of a closed-loop system by reducing peak postprandial glucose excursions. Another line of investigation is seeking to determine whether a combination of insulin and glucagon through a dual-hormone infusion pump could reduce the risk of late postmeal and nocturnal hypoglycemia by feedback-controlled infusion of minidoses.
In addition, investigators are focusing on techniques to increase the rate of insulin absorption by warming the insulin site, using faster-acting insulins, and coformulating insulins with hyaluronidase to reduce the variability of absorption of rapid analogue insulins such as insulin lispro (Humalog) or insulin aspart (NovoLog).
But before closed-loop systems can be confidently used in the outpatient setting, several kinks still need to be worked out.
"The major obstacle, without a doubt in my mind, is that every safeguard must be in place to prevent injury to a patient due to insulin overdelivery as a result of a system error," Dr. Tamborlane said.
He disclosed serving as a consultant to Boehringer Ingelheim, Halozyme, Insuluine, LifeScan/Animas, Medtronic, Novo Nordisk, and Unomedical, and serving on the Novo Nordisk speakers bureau.
