Is an artificial pancreas (closed‐loop system) for Type 1 diabetes effective?

The artificial pancreas is now a viable treatment option for people with Type 1 diabetes and has demonstrated improved glycaemic outcomes while also reducing the onus of self‐management of Type 1 diabetes. Closed‐loop glucose‐responsive insulin delivery guided by real‐time sensor glucose readings can accommodate highly variable day‐to‐day insulin requirements and reduce the hypoglycaemia risk observed with tight glycaemic control in Type 1 diabetes. In 2011, the James Lind Alliance research priorities for Type 1 diabetes were produced and priority 3 was to establish whether an artificial pancreas (closed‐loop system) for Type 1 diabetes is effective. This review focuses on the progress that has been made in the evolution of closed‐loop systems as an effective treatment option for Type 1 diabetes. Development of closed‐loop systems has advanced from feasibility evaluations in highly supervised settings over short periods, to clinical studies in free‐living, unsupervised conditions lasting several months. The approval in the USA of the first hybrid closed‐loop system (MiniMed® 670G pump, Medtronic, Northridge, CA, USA) in 2016 for use in Type 1 diabetes reflects these advancements. We discuss the evidence from clinical studies that closed‐loop systems are effective with improved glycaemic outcomes, reduced hypoglycaemia and had positive end‐user acceptance in children, adolescents, adults and pregnant women with Type 1 diabetes. We also present the outlook for future closed‐loop systems in the treatment of Type 1 diabetes and identify the challenges facing the wide‐spread clinical adoption of this technology.

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