ReviewDiabetes therapy : research, treatment and education of diabetes and related disorders2017
A Review of the Current Challenges Associated with the Development of an Artificial Pancreas by a Double Subcutaneous Approach.
Review in Diabetes therapy : research, treatment and education of diabetes and related disorders, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 46 citations in OpenAlex.
- Pooled it
- Materials and System Design for Self-Decision Bioelectronic Systems.Advanced materials (Deerfield Beach, Fla.) · 2026Review
- Nano-Amounts of Glucagon Premixed With Fast-Acting Insulin Lispro: Effect on Insulin Absorption in Pigs.Current therapeutic research, clinical and experimental · 2025Article
- The Future of Diabetes Care: Exploring the Potential of Bioartificial Pancreas and Do-It-Yourself Artificial Pancreas System Innovations.Pathobiology : journal of immunopathology, molecular and cellular biology · 2025Review
- The Role of the Pancreatic Extracellular Matrix as a Tissue Engineering Support for the Bioartificial Pancreas.Biomimetics (Basel, Switzerland) · 2024Review
- Effects of Low-Dose Glucagon on Subcutaneous Insulin Absorption in Pigs.Current therapeutic research, clinical and experimental · 2024Article
- The Evolution of Pharmacological ActivitiesPharmaceuticals (Basel, Switzerland) · 2022Review
- Vasodilatory effects of glucagon: A possible new approach to enhanced subcutaneous insulin absorption in artificial pancreas devices.Frontiers in bioengineering and biotechnology · 2022Article
- Towards the Integration of an Islet-Based Biosensor in Closed-Loop Therapies for Patients With Type 1 Diabetes.Frontiers in endocrinology · 2022Article
- A Hybrid Automata Approach for Monitoring the Patient in the Loop in Artificial Pancreas Systems.Sensors (Basel, Switzerland) · 2021Article
- Feasibility of large experimental animal models in testing novel therapeutic strategies for diabetes.World journal of diabetes · 2021Review
- Intraperitoneal insulin administration in pigs: effect on circulating insulin and glucose levels.BMJ open diabetes research & care · 2021Article
- Intraperitoneal and subcutaneous glucagon delivery in anaesthetized pigs: effects on circulating glucagon and glucose levels.Scientific reports · 2020Article
- Blood glucose regulation and control of insulin and glucagon infusion using single model predictive control for type 1 diabetes mellitus.IET systems biology · 2020Article
- A Novel Needle-Injectable Millimeter scale Wireless Electrochemical Glucose Sensing Platform for Artificial Pancreas Applications.Scientific reports · 2019Article
- Artificial Pancreas: Current Progress and Future Outlook in the Treatment of Type 1 Diabetes.Drugs · 2019Review
- Feasibility of Early Meal Detection Based on Abdominal Sound.IEEE journal of translational engineering in health and medicine · 2019Article
- Artificial Pancreas or Novel Beta-Cell Replacement Therapies: a Race for Optimal Glycemic Control?Current diabetes reports · 2018Review
- Intraperitoneal, subcutaneous and intravenous glucagon delivery and subsequent glucose response in rats: a randomized controlled crossover trial.BMJ open diabetes research & care · 2018Article
- Effect of sensor location on continuous intraperitoneal glucose sensing in an animal model.PloS one · 2018Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionPatients with diabetes type 1 (DM1) struggle daily to achieve good glucose control. The last decade has seen a rush of research groups working towards an artificial pancreas (AP) through the application of a double subcutaneous approach, i.e., subcutaneous (SC) continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion. Few have focused on the fundamental limitations of this approach, especially regarding outcome measures beyond time in range.
methodsBased on insulin physiology, the limitations of CGM, SC insulin absorption, meal challenge, and physical activity in DM1 patients, we discuss the limitations of the double SC approach. Finally, we discuss safety measures and the achievements reported in some recent AP studies that have utilized the double SC approach.
resultsMost studies show that a double SC AP increases the time in range compared to a sensor-augmented insulin pump and shortens the time in hypoglycemia. Despite these achievements, the proportion of time spent in hyperglycemia is still roughly 20-40%, and hypoglycemia is still present 1-4% of the time. The main factors limiting further progress are the latency of SC CGM (at least 5-10 min) and the slow pharmacokinetics of SC-delivered fast-acting insulin. The maximum blood insulin level is reached after 45 min and the maximum glucose-lowering effect is observed after 1.5-2 h, while the glucose-lowering effect lasts for at least 5 h.
conclusionsAlthough using a double SC AP leads to significant improvements in glucose control, the SC approach has severe limitations that hamper further progress towards a robust AP.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.