Bringing closed-loop home: recent advances in closed-loop insulin delivery

PURPOSE OF REVIEW: To highlight the recent advances in closed-loop research, the development and progress towards utilizing closed loop outside of the clinical research setting and at patients' homes.

RECENT FINDINGS: In spite of the modern insulin therapy in type 1 diabetes, hypoglycaemia is still a major limiting factor. This often leads to suboptimal glycaemic control and risk of diabetes complications. Closed loop has been shown to improve glycaemic control whilst avoiding hypoglycaemia. Incremental progress has been made in this field, from the use of automated systems and bihormonal closed-loop systems in clinical research facility settings under close supervision to the use of ambulatory closed-loop prototype at patients' homes in free-living conditions. Different population of patients with type 1 diabetes and control algorithm approaches have been studied, assessing the efficacy and safety. Transitional and home studies present different challenges at achieving better glycaemic outcome with closed loop. Improved glucose sensor reliability may accelerate the clinical use and faster insulin analogues increase the clinical utility.

SUMMARY: Results and experience with closed-loop insulin delivery have been encouraging, leading the way for future improvements and development in the field, to make closed loop suitable for use in clinical practice.