Open vs closed loop insulin infusion systems

Abstract

Closed-loop insulin infusion systems, also known as artificial pancreases, represent a significant advance in the management of type 1 diabetes. These devices integrate a continuous glucose monitor, an insulin pump, and a control algorithm that automatically adjusts insulin administration based on real-time glucose levels. This technology offers substantial advantages over conventional infusion systems and multiple injection regimens.

The efficacy of closed-loop systems is evidenced in multiple clinical studies. A meta-analysis of 40 trials, including 1,027 participants, demonstrated that closed-loop systems significantly increased time in glucose range (70-180 mg/dL) by 9.62% (95% CI: 8.30-10.94) compared to standard treatments. This translates to approximately 2.3 additional hours per day within the target range¹. In addition to improving glycemic control, these systems reduce the cognitive burden associated with diabetes management. A 12-month prospective cohort study showed a significant decrease in the prevalence of diabetes-related burnout (from 74% to 59%, p=0.001) and an improvement in diabetes-related quality of life (p<0.0001) in users of closed-loop systems². The superiority of these systems also extends to the reduction of acute complications. A 6-month randomized trial in 168 patients with type 1 diabetes reported a 68% reduction in time spent in hypoglycemia (<70 mg/dL) with the use of closed-loop systems compared to standard insulin pump therapy (p<0.001)¹.

It is important to note that, although these systems offer more precise and less invasive control, they require adequate training for both healthcare professionals and patients. As this technology continues to evolve, its adoption is expected to expand, significantly improving the quality of life and clinical outcomes of people with type 1 diabetes.