Roadmap to the artificial pancreas

Objective: To outline a roadmap to the artificial pancreas (AP) comprising a subcutaneous (sc) glucose monitor, a control algorithm, and an insulin pump delivering sc insulin.Research design and methods: A literature review, personal views, and material from the Juvenile Diabetes Research Foundation have been used to prepare the roadmap.Results: The roadmap identifies sensor reliability but not sensor accuracy as the critical roadblock, which can be addressed by advanced control algorithms combined with safety critical features. It is argued that incremental rather than perfect glucose control should be the objective of the first generation of the AP. Overnight glucose control is more easily achieved than postmeal control and could be the first aim for a commercial AP. Glycated haemoglobin and the risk of hypoglycaemia will remain the primary efficacy and safety measures being accompanied by complementary measures of variability of glucose excursions. Research priorities include the development of AP prototypes incorporating existing glucose monitors with focus on evaluation at home over short- and long-term periods.Conclusions: The AP promises to revolutionise insulin treatment. Building on technological progress in glucose sensing, the true potential of the AP needs to be assessed by building prototypes and evaluations in home settings.