The Artificial Pancreas: A Dynamic Challenge

摘要: Abstract In patients with diabetes mellitus type 1, the pancreatic insulin production ceases, causing raise in blood glucose level (BGL) and potentially severe long-term complications. The "holy grail" of treatment is artificial pancreas (AP), a closed-loop control system that regulates user’s BGL by infusing insulin, possibly glucagon. Numerous attempts have been largely unsuccessful, mainly due to slow dynamics make it difficult avoid unwanted excursions. System performance has improved through sensor technology faster-acting types, but risk hypoglycemia still significant unless setpoint unnaturally high. We argue this problem can be circumvented choosing appropriate sites for measurement infusion. While intravascular infusion provides fastest thus best conditions control, only viable inpatients danger infections limited durability. On other extreme, state-of-the-art subcutaneous systems exhibit time delays diffusion dynamics, yielding poor event disturbances like meals physical activity. Avoiding dangerous therefore comes at expense daily episodes elevated (typically 10-15 mmol/L) increase Furthermore, uptake from subcutis remains as major challenge. Hence we advocate double intraperitoneal (IP) AP. Here, released into abdominal cavity (peritoneum) semi-permanent port, which also allows access IP sensing. This improves both sensing absorption dynamics. Thus may significantly tighter, allowing closer healthy normal approximately 4.5 mmol/L whilst improving safety. These statements are supported results our own research literature.