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Closed-loop delivery of insulin

Progress to date for diabetes mellitus therapy

  • Emerging Technology
  • Published:
American Journal of Drug Delivery

Abstract

The importance of exactly matching blood glucose levels in patients with diabetes mellitus with the dose and timing of insulin cannot be overemphasized. This is true for both type 1 and type 2 diabetes. The prevention of the serious consequences of diabetes should be a therapeutic goal because of the personal and national economic costs of treating the disease and its sequelae. Avoidance of sequelae cannot be achieved without so-called intensive treatment of the disease; however, this is a difficult and sometimes hazardous process. An automated and ’safe’ method of achieving intensive treatment (closed-loop insulin delivery) has been an important focus of research for many years since it was realized that the simple replacement of insulin saved the lives of patients with diabetes, but did not guarantee good health.

Following the general successes of organ transplant, the obvious line of enquiry in the last three decades was to replace the pancreas with donor tissue; however, even when superseded by the simpler process of islet transplant, the benefits of this have not been widespread. This is because of the shortcomings and incompatibilities of immunosuppression with the functioning of the graft, among other problems. The two types of rejection that may occur in the presence of the autoimmune type of diabetes further endanger graft function; however, recently there have been advances that have partially solved this problem. Nevertheless, the lifetime risks of immunosuppression and the shortage of donor material still make transplant less attractive than first thought.

Consequently, other approaches to closed-loop insulin delivery have been important. These include implantable pumps coupled with sensors and a range of devices incorporating glucose-sensitive materials that could be engineered into delivery systems to work by closed loop. Each of these has relative advantages and drawbacks, but some have the capacity to reach the market for clinical use. Of these, the MiniMed pump would appear to be in the lead, and is at present undergoing clinical trials that have given promising results but that have not yet entirely solved the closed-loop problem. Other designs may yet become important contenders in this interesting contest.

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  1. Leicester School of Pharmacy, De Montfort University, The Gateway, Leicester, LE1 9BH, UK

    M. Joan Taylor, Sangeeta Tanna & Tarsem S. Sahota

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  1. M. Joan Taylor
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Taylor, M.J., Tanna, S. & Sahota, T.S. Closed-loop delivery of insulin. Am J Drug Deliv 2, 1–13 (2004). https://doi.org/10.2165/00137696-200402010-00001

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