Insulin pump development started in 1978, with the first commercially available glucose sensor marketed in 1999. Combining these two instruments is a logical step toward the closed loop. This article discusses three questions: Is pump development complete? How can a pump and a sensor be combined? Can the delay problem associated with the subcutaneous-subcutaneous approach for the closed loop be overcome?
PickupJMattockMKerryS. Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta-analysis of randomised controlled trials. BMJ. 2002; 324: 1–5.
2.
RetnakaranR.HochmanJ.DeVriesJ.H.Hanaire-BroutinH.HeineR.J.MelkiV.ZinmanB. Continuous subcutaneous insulin infusion vs multiple daily injections: the impact of baseline A1c. Diabetes Care. 2004; 27: 2590–6.
3.
BolliGBCapaniFHomePDKerrDThomasRTorleoneESelamJLSola-CazagnesAVitacolonnaE. Comparison of a multiple daily injection regimen with once-daily insulin glargine basal insulin and mealtime lispro, to continuous subcutaneous insulin infusion: a randomised, open, parallel study. Diabetes. 2004; 53: A107–8.
4.
BruttomessoDCrazzolaraDCostaSGirelliALeporeGAragonaMValentiniUTrevisanRDel PratoSBuhrATiengoAMaranA. Comparison between CSII with multiple basal lispro infusion rates and MDI with lispro and glargine. Diabetologia. 2007; 49 (S1): 590.
5.
ChaseHPHornerBMcFannKYetzerHGastonJBanionCFiallo-ScharerRSloverRKlingensmithG. The use of insulin pumps with meal bolus alarms in children with type 1 diabetes to improve glycemic control. Diabetes Care. 2006; 29: 1012–5.
6.
DeissDBolinderJRivelineJPBattelinoTBosiETubiana-RufiNKerrDPhillipM. Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring. Diabetes Care. 2006; 29: 2730–2.
7.
HirschIBBodeBWAbelsethJFischerJKaufmanFRMastrototaroJWolpertHABuckinghamB. Sensor augmented pump therapy: results of the first treat-to-target study. Diabetes. 2007; 56 (S1): A24.
PfutznerAMannAESteinerSS. Technosphere/Insulin—a new approach for effective delivery of human insulin via the pulmonary route. Diabetes Technol Ther. 2002; 4: 589–94.
10.
WentholtIMHartAAHoekstraJBDeVriesJH. Relationship between interstitial and blood glucose in type 1 diabetes patients: delay and the push-pull phenomenon revisited. Diabetes Technol Ther. 2007; 9: 169–75.