The Artificial Pancreas

The discovery of insulin was lifesaving. However,it converted type 1 diabetes, which had been anacute and lethal disease, into a chronic disease,with its attendant complications. It had long been considered—and was clearly demonstrated in the Diabetes Control and Complications Trial (1)—that micro-vascular complications such as retinopathy, nephropathy, and neuropathy (as well as micro- and macrovascular legacy effects) were improved with intensive glucose control—that is, when circulating glucose levels were closer to those seen in the nondiabetic state. This entailed increased involvement on the part of a person with di-abetes in their management: glucose monitoring, frequent insulin injections, or continuous subcutaneous insulin in-fusion (CSII). It also increased the risk of hypoglycemia. The mitigation of this trade-off, as well as controlling “brittle ” diabetes, improving the quality of life of the per-son with diabetes, and the availability of the necessar