Pursuit of a closed-loop artificial pancreas that automatically controls the blood glucose of individuals with type 1 diabetes has intensified during the past 6 years. Here we discuss the recent progress and challenges in the major steps towards a closed-loop system. Continuous insulin infusion pumps have been widely available for over two decades, but “smart pump” technology has made the devices easier to use and more powerful. Continuous glucose monitoring (CGM) technology has improved and the devices are more widely available. A number of approaches are currently under study for fully closed-loop systems; most manipulate only insulin, while others manipulate insulin and glucagon. Algorithms include on–off (for prevention of overnight hypoglycemia), proportional–integral–derivative (PID), model predictive control (MPC) and fuzzy logic based learning control. Meals cause a major “disturbance” to blood glucose, and we discuss techniques that our group has developed to predict when a meal is likely to be consumed and its effect. We further examine both physiology and device-related challenges, including insulin infusion set failure and sensor signal attenuation. Finally, we discuss the next steps required to make a closed-loop artificial pancreas a commercial reality.

在过去的 6 年里，对自动控制 1 型糖尿病患者血糖的闭环人工胰腺的追求越来越强烈。在这里，我们讨论了实现闭环系统的主要步骤的最新进展和挑战。连续胰岛素输注泵已经广泛使用了二十多年，但“智能泵”技术使这些设备更易于使用且功能更强大。连续血糖监测 (CGM) 技术得到了改进，设备的应用范围也越来越广。目前正在研究一些用于全闭环系统的方法；大多数只操纵胰岛素，而其他操纵胰岛素和胰高血糖素。算法包括开-关（用于预防夜间低血糖）、比例-积分-微分（PID）、模型预测控制 (MPC) 和基于模糊逻辑的学习控制。进餐会对血糖造成严重的“干扰”，我们讨论了我们小组开发的用于预测何时可能食用进餐及其影响的技术。我们进一步研究了生理学和设备相关的挑战，包括胰岛素输液器故障和传感器信号衰减。最后，我们讨论了使闭环人工胰腺成为商业现实所需的后续步骤。