The artificial pancreas From logic to life

In this thesis we investigated the efficacy of real-life use of an artificial pancreas starting with use of these systems in a hotel setting and finally 24/7 long-term use at home. We investigated the accuracy of continuous glucose monitoring (CGM) systems that act as input for the artificial pancreas or for use in combination with an insulin pump or pen. Since CGM data are used for insulin-dosing, their accuracy and reliability are essential. Our research on two commonly used CGM systems indicates that measurement accuracy differs to an extent that is clinically relevant. We show that a novel category of implantable CGM can perform safely and accurately over a lifetime of up to 180 days whereas current CGM have a lifetime of 7 days. Innovations as these provide opportunities for use in artificial pancreas systems. Our results indicate that an artificial pancreas can be used safely and effectively not only during night-time in a hotel environment but also during long term day and night use. The artificial pancreas improves glycaemic control including a reduction of time spent in hypoglycaemia, hyperglycaemia and HbA1c compared to open-loop use of a sensor and pump. Use of an adaptive, self-learning, artificial pancreas further improves glycaemic control during night-time. Participants appreciate the positive effects on glucose regulation but technical errors limit their appreciation for the current system. We conclude that the artificial pancreas facilitates good glucose control and holds the promise to alleviate the disease burden improving the life of a person with diabetes substantially.