Page 322 - Glucose Monitoring Devices

The way forward: the JDRF roadmap to an artificial pancreas 329

old, adolescents defined as 14e25 years old, and adults defined as >25 years old),
only the adult cohort showed a lowering of HbA1c levels ( 0.5%) with the use of
sensor therapy at the end of the 26-week trial [13]. However, secondary analyses
of the data confirmed that beneficial impacts of the sensor were documentable in
all study participants who, regardless of the age cohort, used the sensor at least
6 days per week [13].
In recent years, CGM use in persons with T1D has grown exponentially [12].
Several factors played a role including increased duration of wear to 1e2 weeks’
time and factory calibrations in some of the systems that obviate the need for finger-
stick calibration. Similarly, substantial improvements in accuracy have been
achieved. Furthermore, the US Food and Drug Administration (FDA) approval of
nonadjunctive CGM use, whereby treatment decisions can be made based on sensor
glucose values, may have also provided the impetus for patients to embrace this
technology [14,15].

The way forward: the JDRF roadmap to an artificial pancreas
With the building blocks assembled, the quest to automate insulin delivery was
undertaken. JDRF created the Artificial Pancreas (AP) Project in 2006, forging a
path forward to boost scientific research in creating a commercially available
closed-loop system for patients with T1D. Furthermore, a “roadmap” (Fig. 16.1)
was created to clearly define the steps in the process of automation, recognizing
that insulin suspension based on low sensor glucose values was inherently less risky

FIGURE 16.1
Revised AP road map. AP system development can be condensed from six steps to three
and has bifurcated into automated insulin delivery approaches utilizing solely insulin and
multihormone approaches, which may utilize insulin and glucagon, insulin and amylin, or
insulin and other glucose-modulating agents.
Used with permission from Kowalski A. Pathway to artificial pancreas systems revisited: moving downstream.
Diabetes Care 2015;38(6):1036e1043.