Journal Article Review Ppublish
PubMed: 40590464 DOI: 10.1177/19322968251338754
Research Gaps, Challenges, and Opportunities in Automated Insulin Delivery Systems.
J Diabetes Sci Technol 19(4):937-949
Authors: Peter G Jacobs, Carol J Levy, Sue A Brown, Michael C Riddell, Ali Cinar, Charlotte K Boughton, Marc D Breton, Eyal Dassau, Greg Forlenza, Robert J Henderson, Roman Hovorka, David M Maahs, Medha Munshi, Helen Murphy, Sarit Polsky, Richard Pratley, Melissa S Putman, Viral N Shah, Leah M Wilson, Howard Zisser, Laya Ekhlaspour
Affiliations
- College of Bioengineering, Oregon State University, Corvallis, OR, USA.
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- University of Virginia, Charlottesville, VA, USA.
- York University, Toronto, ON, Canada.
- Department of Chemical and Biological Engineering, Illinois Institute of Technology, Chicago, IL, USA.
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA.
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Jaeb Center for Health Research, Tampa, FL, USA.
- Stanford University, Palo Alto, CA, USA.
- Joslin Diabetes Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Kings College London, London, UK.
- Advent Health Translational Research Institute, Orlando, FL, USA.
- Diabetes Research Center, Massachusetts General Hospital, Boston, MA, USA.
- School of Medicine, Indiana University, Indianapolis, IN, USA.
- Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR, USA.
- University of California, Santa Barbara, Santa Barbara, CA, USA.
- Division of Pediatric Endocrinology, University of California, San Francisco, San Francisco, CA, USA.
Abstract
BACKGROUND
Since the discovery of the life-saving hormone insulin in 1921 by Dr Frederick Banting in 1921, there have been many critical discoveries and technical breakthroughs that have enabled people living with type 1 diabetes (T1D) to live longer, healthier lives. The development of insulin pumps, continuous glucose monitoring (CGM) systems, and automated insulin delivery (AID) systems have enabled people living with T1D to safely manage their glucose, reduce their HbA1c, and improve their overall health and quality of life. Nevertheless, AID systems are not yet designed for all people with T1D, and they perform best during the overnight period when meals and exercise are not occurring. AID systems are not fully automated in that they require the person using the system to announce meals and exercise to the system to avoid dangerous hyper- or hypoglycemia, respectively.
METHODS
In this review, which is one of a collection of manuscripts to commemorate the 75th anniversary of the National Institute for Diabetes and Digestive and Kidney Diseases, we celebrate the commercialization of the AID and discuss the major challenges and research gaps that remain to be solved to enable single- and multi-hormone AID systems to more fully support glucose management in people living with T1D.
RESULTS
More research is required to design and evaluate more intelligent AID systems that do not require accurate carbohydrate estimations or announcements for meals and exercise. Current AID systems are also not designed to be used by older adults or pregnant people. Results are presented on new AID systems that can automatically respond to meals and exercise. Results are also presented on evaluations of AID systems in older adults and pregnant people.
CONCLUSIONS
Next-generation AID systems will need to support all people, including older adults, people during pregnancy, athletes, and people who may be too busy to announce carbohydrates or exercise to the system. Solutions are now becoming available that will enable AID systems to support a broader range of people living with T1D by leveraging the latest technologies in artificial intelligence and adaptive control.
MeSH
Diabetes Mellitus, Exercise, Pancreas, Artificial, Pregnancy, Insulin, Hyperglycemia, Hormones, Research, Meals, Hypoglycemia, Carbohydrates