Artificial pancreas: fuzzy logic and control of glycemia

This review describes the latest efforts, challenges, and experience of using automated insulin delivery systems at outpatient settings and home studies. This is an important step in getting recognition of these systems as a routine therapy for patients with type 1 diabetes.

Almost 3 years elapsed since the first description of closed-loop use outside the protecting environment of the hospital, at a diabetes camp. In this period, several different approaches of closed-loop systems were used at outpatient settings. The low-glucose suspend feature on the pump showed a reduction in the risk of nocturnal hypoglycemia. Closed-loop systems with diverse control algorithms with a single or bihormonal approach showed an improvement in glycemic control. The improvement was demonstrated during the overnight use and during the 24-h use. The outpatient studies with closed-loop systems, especially overnight at home, demonstrated that the current configurations are already safe and efficient for daily use. Technological advancement should undoubtedly lead to even better performance.

Studies using closed-loop systems at patients' home are currently being carried out. The preliminary results of these experiments are encouraging and enhance our confidence in this tool as suitable for use in clinical daily practice.