Closing the Loop

Clinical Results of an Automated Artificial Pancreas Using Technosphere Inhaled Insulin to Mimic First-Phase Insulin Secretion

“…35,36 In patients with type 1 diabetes using insulin glargine, a randomized trial showed that prandial TI led to significantly lower fasting and 1-and 2-hour postprandial glucose values compared to prandial insulin lispro, with a lower hypoglycemia event rate. 37 Several other published clinical studies have further supported TI's safety and efficacy as a prandial insulin in type 1 diabetes 29,38,39 and type 2 diabetes. 29,40,41 At the time of the study TI was an investigational drug that was approved on June 27, 2014, as an ultra rapid-acting insulin for oral inhalation indicated for the treatment of adults with type 1 or type 2 diabetes mellitus in the US by the food and drug administration.…”

“…37 Several other published clinical studies have further supported TI's safety and efficacy as a prandial insulin in type 1 diabetes 29,38,39 and type 2 diabetes. 29,40,41 At the time of the study TI was an investigational drug that was approved on June 27, 2014, as an ultra rapid-acting insulin for oral inhalation indicated for the treatment of adults with type 1 or type 2 diabetes mellitus in the US by the food and drug administration. 42,43 Because of its short action profile, TI can significantly blunt the postprandial glucose excursion even if delivered at the start of a meal rather than in advance.…”

“…24,25 By contrast, subcutaneously injected rapid-acting insulin analogs show a comparatively smooth ascent up to their peak blood concentration (over 40 minutes after injection) and peak glycemic effect (well over an hour after injection). 26,27 The action profile of subcutaneously delivered insulin analogs can be enhanced by a variety of methods under investigation, including coadministration with recombinant human hyaluronidase, 28 coformulation with disodium EDTA and citrate, 29 and heating the site of infusion or injection; 30 each of these methods could be useful in an AP. Even more favorable pharmacokinetics and pharmacodynamics might be achievable through a different route of insulin administration, such as intraperitoneal 31 or—as we describe in this article—pulmonary.…”

Manual Closed-Loop Insulin Delivery Using a Saddle Point Model Predictive Control Algorithm: Results of a Crossover Randomized Overnight Study

“…Recent advances in insulin pumps, continuous glucose monitoring (CGM) devices, and control algorithms have resulted in an acceleration of progress in the development of an artificial pancreas. 1-3 One of the paramount goals of an artificial pancreas is to improve nocturnal glycemic control. Several control algorithms have been tested aiming at both reducing nocturnal hypoglycemia and increasing the time spent in normoglycemia.…”