[Closed-Loop at night for the treatment of type 1 diabetes]

This mini-review describes the latest efforts, challenges, and experience of using automated insulin delivery systems at outpatient settings and home studies. Predictive low glucose management (PLGM) may help prevent hypoglycemia by stopping insulin pump delivery based on predicted sensor glucose values. In silico modeling and early feasibility data demonstrate that PLGM may further reduce the severity of hypoglycemia beyond that already established for algorithms that use a threshold-based suspension. Recent studies have shown that an closed-loop system can improve glucose control and reduce nocturnal hypoglycemia. In the multinational, multicenter DREAM project patients at a diabetes camp who were treated with an artificial-pancreas system had less nocturnal hypoglycemia and tighter glucose control than when they were treated with a sensor-augmented insulin pump. 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.