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Continuous glucose monitoring and closed-loop systems.
Diabet Med. 2006 Jan; 23(1):1-12.DM

Abstract

BACKGROUND

The last two decades have witnessed unprecedented technological progress in the development of continuous glucose sensors, resulting in the first generation of commercial glucose monitors. This has fuelled the development of prototypes of a closed-loop system based on the combination of a continuous monitor, a control algorithm, and an insulin pump.

METHOD

A review of electromechanical closed-loop approaches is presented. This is followed by a review of existing prototypes and associated glucose sensors. A literature review was undertaken from 1960 to 2004.

RESULTS

Two main approaches exist. The extracorporeal s.c.-s.c. approach employs subcutaneous glucose monitoring and subcutaneous insulin delivery. The implantable i.v.-i.p. approach adopts intravenous sampling and intraperitoneal insulin delivery. Feasibility of both solutions has been demonstrated in small-scale laboratory studies using either the classical proportional-integral-derivative controller or a model predictive controller. Performance in the home setting has yet to be demonstrated.

CONCLUSIONS

The glucose monitor remains the main limiting factor in the development of a commercially viable closed-loop system, as presently available monitors fail to demonstrate satisfactory characteristics in terms of reliability and/or accuracy. Regulatory issues are the second limiting factor. Closed-loop systems are likely to be used first by health-care professionals in controlled environments such as intensive care units.

Authors+Show Affiliations

Diabetes Modelling Group, Department of Paediatrics, University of Cambridge, Cambridge, UK. r.hororka@uk.avecho.com

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

16409558

Citation

Hovorka, R. "Continuous Glucose Monitoring and Closed-loop Systems." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 23, no. 1, 2006, pp. 1-12.
Hovorka R. Continuous glucose monitoring and closed-loop systems. Diabet Med. 2006;23(1):1-12.
Hovorka, R. (2006). Continuous glucose monitoring and closed-loop systems. Diabetic Medicine : a Journal of the British Diabetic Association, 23(1), 1-12.
Hovorka R. Continuous Glucose Monitoring and Closed-loop Systems. Diabet Med. 2006;23(1):1-12. PubMed PMID: 16409558.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Continuous glucose monitoring and closed-loop systems. A1 - Hovorka,R, PY - 2006/1/18/pubmed PY - 2006/5/9/medline PY - 2006/1/18/entrez SP - 1 EP - 12 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet Med VL - 23 IS - 1 N2 - BACKGROUND: The last two decades have witnessed unprecedented technological progress in the development of continuous glucose sensors, resulting in the first generation of commercial glucose monitors. This has fuelled the development of prototypes of a closed-loop system based on the combination of a continuous monitor, a control algorithm, and an insulin pump. METHOD: A review of electromechanical closed-loop approaches is presented. This is followed by a review of existing prototypes and associated glucose sensors. A literature review was undertaken from 1960 to 2004. RESULTS: Two main approaches exist. The extracorporeal s.c.-s.c. approach employs subcutaneous glucose monitoring and subcutaneous insulin delivery. The implantable i.v.-i.p. approach adopts intravenous sampling and intraperitoneal insulin delivery. Feasibility of both solutions has been demonstrated in small-scale laboratory studies using either the classical proportional-integral-derivative controller or a model predictive controller. Performance in the home setting has yet to be demonstrated. CONCLUSIONS: The glucose monitor remains the main limiting factor in the development of a commercially viable closed-loop system, as presently available monitors fail to demonstrate satisfactory characteristics in terms of reliability and/or accuracy. Regulatory issues are the second limiting factor. Closed-loop systems are likely to be used first by health-care professionals in controlled environments such as intensive care units. SN - 0742-3071 UR - https://www.unboundmedicine.com/medline/citation/16409558/Continuous_glucose_monitoring_and_closed_loop_systems_ L2 - https://doi.org/10.1111/j.1464-5491.2005.01672.x DB - PRIME DP - Unbound Medicine ER -