According to the IDF Diabetes Atlas, there are currently 589 million adults (20-79 years) living with diabetes worldwide, and that number is expected to grow to 853 million by 2050. While there are several management options available for diabetes, the condition continues to impact public health. However, in recent years, an artificial pancreas system (APS) has been designed and tested, built to help individuals, particularly those with type 1 diabetes, manage blood glucose levels. Here, we'll review what artificial pancreas systems are and how they can impact the future of diabetes care.
Understanding How the Pancreas Works
The function of a healthy pancreas is to produce insulin, which helps move glucose from the blood into the cells for energy. The pancreas also makes glucagon, which sends a signal to the liver to release stored glucose when blood sugar levels get too low. Together, these two hormones work to keep blood sugar levels balanced throughout the day.
However, in people with type 1 diabetes, the pancreas does not produce insulin. And in people with type 2 diabetes, the body may not use insulin effectively, or it may not produce enough insulin to control blood glucose sufficiently. Other forms of diabetes also have some issues with how the pancreas functions, but the underlying cause may be different.
What Is an Artificial Pancreas System?
Artificial pancreas systems are designed to mimic the function of a healthy pancreas. This means that it delivers the right amount of insulin based on real-time blood glucose readings without much help from the person using it. An APS can also be referred to as:
- Automated insulin-delivery system (AID)
- Closed-loop system
The current system in use is a hybrid closed-loop system (HCL), which requires people with diabetes to make adjustments to prevent hypoglycemia during physical activity and announce their meals so that an appropriate quantity of insulin (called a “bolus”) can be delivered. A fully automated closed-loop pancreas is still under development, but would require no manual input for hands-off diabetes management.
Other types of artificial pancreas systems include:
- Threshold Suspend and Predictive Suspend Systems: These stop insulin delivery when low blood sugar is detected to help prevent severe hypoglycemia. Insulin doses are not increased on this system, but it is particularly beneficial for those who experience lows at night.
- Insulin-Only Systems: These focus solely on calculating insulin doses and automating insulin doses based on CGM readings to help keep levels stable.
- Dual Hormone Systems: These are still being researched, but will use both insulin and glucagon to more closely replicate natural pancreatic function
How Does an Artificial Pancreas Work?
Artificial pancreas device systems are made up of three primary parts: a continuous glucose monitor (CGM), an insulin pump, and a control algorithm (program).
Continuous Glucose Monitor
The CGM is a small sensor placed under the skin that measures glucose levels in real time. It continuously tracks your blood sugar throughout the day and night, sending updates to the insulin pump or the system’s control algorithm. By providing a constant stream of glucose data, the CGM allows the system to detect trends (e.g., whether your sugar is rising after a meal or dropping during exercise) so the APS can respond quickly and accurately. There are several benefits of using a continuous glucose monitor on its own as well, but combining it with other diabetes technology can help simplify overall management and care.
Insulin Pump
The insulin pump (or an insulin infusion pump) is a device that delivers insulin into the body through a small cannula placed under the skin. The pump provides continuous basal insulin throughout the day and can deliver bolus doses at mealtimes. In an APS, the pump receives instructions from the control algorithm, adjusting insulin delivery in real time based on the CGM readings.
Control Algorithm or Programs
The control algorithm is the “brain” of the system. It takes the glucose data from the CGM and calculates the exact amount of insulin the pump needs to deliver. Some algorithms are hybrid closed-loop, meaning they automatically adjust basal insulin and provide corrections, but still require the user to enter mealtime carbohydrates. Fully automated algorithms, which are still in development, would ideally manage blood sugar completely without manual input. The algorithm’s intelligence allows the APS to mimic the natural decision-making of a healthy pancreas, predicting trends and adjusting insulin proactively.
Benefits of Artificial Pancreas Systems
Artificial pancreas systems are transforming diabetes management and significantly improving the quality of life for those who use them. Some of the most notable benefits to consider before talking to your doctor include the following:
Improved Blood Glucose Control
One of the most significant benefits of APS is its ability to keep blood glucose levels within the target range. Clinical studies consistently show that APS users experience:
- Higher time-in-range (TIR): Many users see a significant increase in the percentage of time their glucose stays between 70–180 mg/dL.
- Lower A1c: Automated insulin adjustments help reduce average blood sugar over time without increasing the risk of hypoglycemia.
- Reduced glycemic variability: APS smooths out peaks and valleys, preventing extreme highs and lows.
Reduced Risk of Hypoglycemia
Hypoglycemia (dangerously low blood glucose) can be frightening and sometimes life-threatening. APS helps reduce this risk through features like:
- Predictive low-glucose suspend: The system pauses insulin delivery before blood sugar drops too low.
- Automated correction boluses: Insulin delivery is adjusted proactively to prevent rapid fluctuations.
- Nighttime protection: APS is particularly effective at reducing overnight lows, giving users peace of mind while they sleep.
Less Daily Burden and Mental Load
Managing diabetes often involves a high mental load, as you need to make decisions based on blood sugar readings and calculations continually throughout the day. Switching to an APS can help automate parts of your routine and minimize the need for ongoing fingersticks, both of which can help reduce overall stress and anxiety.
Enhanced Quality of Life
Research shows that APS users often report improvements in quality of life, including:
- Greater confidence in daily routines and fewer interruptions due to glucose management.
- Improved sleep thanks to fewer nighttime alarms and hypoglycemic events.
- Reduced anxiety related to diabetes management, particularly for parents of children with type 1 diabetes.
Potential Long-Term Health Benefits
By improving time-in-range and reducing glucose extremes, APS may help lower the risk of diabetes-related complications such as:
- Cardiovascular disease
- Kidney disease
- Neuropathy and retinopathy
While long-term studies are ongoing, early evidence suggests that consistent use of APS could support healthier outcomes over time.
Challenges and Limitations
As with any up-and-coming technology, there are still a few challenges and limitations to getting and using an APS. Some of the most notable include:
- APS devices are expensive, and insurance coverage is not always guaranteed.
- Users need to learn how to operate, maintain, and troubleshoot the technology.
- Most systems still require manual carbohydrate entry at mealtimes.
- Sensors and infusion sets need regular calibration and replacement.
- Current APS models are not fully automated and still need user input.
- Dual hormone systems face challenges with glucagon stability and cost.
- Stress, illness, and lifestyle factors can still affect glucose control.
- Device alarms and constant monitoring may lead to technology fatigue.
- Access to APS varies by region, and healthcare inequities limit availability.
If you're interested in using an artificial pancreas system, it's essential to have a conversation with your doctor about whether it's the right tool for you.
Current Availability and FDA Approval
According to the FDA website, in 2016, they "collaborated with diabetes patient groups, diabetes care providers, medical device manufacturers, researchers, and academic investigators to foster innovation by clarifying agency expectations for clinical studies and product approvals." This collaboration led to the approval of the Medtronic MiniMed 670G System as the first hybrid closed-loop system available on the market (when paired with a CGM). Since then, additional models have been introduced, such as the Medtronic MiniMed 770G and the Medtronic MiniMed 780G.
Various manufacturers have since created additional models of automated insulin delivery systems. Some of the most notable ones on the market include:
In 2023, a move toward more automation was made. The Beta Bionics iLet ACE Pump and the iLet Dosing Decision Software were cleared by the FDA for children with type 1 diabetes aged six and up, along with adults. When combined with the FDA-cleared integrated continuous glucose monitor (iCGM), they formed a new system called the iLet Bionic Pancreas.
Are Artificial Pancreas Systems the Future?
Artificial pancreas systems represent one of the most promising advances in diabetes management, helping many people achieve better glucose control with less daily stress. While they’re not a perfect tool, the technology continues to evolve, offering a path toward a future where managing diabetes feels less overwhelming. For those living with type 1 or insulin-dependent type 2 diabetes, these systems may increasingly become the standard of care. To help supplement your management plan, Byram Healthcare is here to ensure you always have what you need. Order from our online diabetes product catalog today to receive supplies shipped directly to your doorstep.
