In the 100 years since the discovery of insulin, there have been significant technological advances in diabetes management. As a result, a majority of people with type 1 diabetes are unable to achieve the recommended therapeutic targets ( 3).

However, optimal glycemic control in many individuals with type 1 diabetes is limited by hypoglycemia and the high burden of self-management required with frequent monitoring of blood glucose and adjustment of insulin dosing ( 2). The goal of intensive insulin therapy is to mimic physiological insulin release by pancreatic beta cells in a basal-bolus fashion to achieve tight glycemic control and thereby reduce the risk of micro- and macrovascular complications of hyperglycemia ( 1). The mainstay of treatment for type 1 diabetes is intensive insulin therapy, either as multiple daily injections or continuous subcutaneous insulin infusion via pump. Another evolving avenue in research is the addition of glucagon to mitigate the risk of hypoglycemia and allow more aggressive insulin dosing. Future challenges in closed-loop technology include the development of fully closed-loop systems that do not require user input for meal announcements or carbohydrate counting. As the number of commercially available hybrid closed-loop systems has grown, so too has the evidence supporting their efficacy. These modern closed-loop systems use interstitial glucose sensing, subcutaneous insulin pumps, and increasingly sophisticated algorithms. Only recently have these bulky, bedside technologies progressed to miniaturized, wearable devices. The first iterations of glucose-responsive insulin delivery were pioneered in the 1960s and 1970s, with the development of systems that used venous glucose measurements to dictate intravenous infusions of insulin and dextrose in order to maintain normoglycemia. Department of Endocrinology, St Vincent’s Hospital, Sydney, NSW, AustraliaĬlosed-loop (artificial pancreas) systems for automated insulin delivery have been likened to the holy grail of diabetes management.

Past delivery