Artificial pancreas: A review of fundamentals and inpatient and outpatient studies

The artificial pancreas (AP) is a device for automated modulation of insulin infusion that aims to maintain blood glucose in a nearly normal range. The core of the AP is the control algorithm, which is in charge of computing an effective insulin dose on the basis of continuous glucose monitoring readings. In the last 6 years, AP prototypes based on subcutaneous glucose sensing and subcutaneous insulin delivery have been extensively studied in clinical trials first on hospitalized patients and, more recently, in an outpatient setting. In this chapter we review the state of the art of the field, starting with a description of the various AP system components. In particular, we focus on the control techniques employed in the AP and on the principles on which they are based. We then move to AP testing: The preclinical stage (mostly done in silico), the inpatient clinical studies, and finally the outpatient studies. We also discuss the technological requirements for an ambulatory AP.