Closed-loop control in insulin pumps for type-1 diabetes mellitus: safety and efficacy

Expert Rev Med Devices. 2020 Jul;17(7):707-720. doi: 10.1080/17434440.2020.1784724. Epub 2020 Jul 3.


Introduction: Type 1 diabetes is a lifelong disease with high management burden. The majority of people with type 1 diabetes fail to achieve glycemic targets. Algorithm-driven automated insulin delivery (closed-loop) systems aim to address these challenges. This review provides an overview of commercial and emerging closed-loop systems.

Areas covered: We review safety and efficacy of commercial and emerging hybrid closed-loop systems. A literature search was conducted and clinical trials using day-and-night closed-loop systems during free-living conditions were used to report on safety data. We comment on efficacy where robust randomized controlled trial data for a particular system are available. We highlight similarities and differences between commercial systems.

Expert opinion: Study data shows that hybrid closed-loop systems are safe and effective, consistently improving glycemic control when compared to standard therapy. While a fully closed-loop system with minimal burden remains the end-goal, these hybrid closed-loop systems have transformative potential in diabetes care.

Keywords: Artificial pancreas; automated insulin delivery; closed-loop; continuous glucose monitoring; insulin pump; type 1 diabetes.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Blood Glucose / analysis
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Health Personnel / education
  • Humans
  • Insulin Infusion Systems / adverse effects*
  • Treatment Outcome


  • Blood Glucose