Progressive artificial endocrine pancreas: The era of novel perioperative blood glucose control for surgery.

Strict glycemic control needs to be maintained in critically ill surgical patients to reduce the mortality and morbidity due to hyperglycemia and associated infection. However, conventional intensive insulin therapy (IIT), which consists of intermittent blood glucose measurement and manually controlled infusions of insulin, tends to induce hypoglycemia and glucose variability. Many randomized clinical trials have been conducted to improve the efficacy of IIT, although some of these were stopped owing to frequent hypoglycemia. In pursuing safe and strict glycemic control for critically ill surgical patients, we found that a closed-loop glycemic control system was able to maintain appropriate blood glucose levels without hypoglycemia in more than 400 clinical cases. Considering the need for the perioperative and intensive care environment, a well-established artificial pancreas was modified into a new closed-loop glycemic control system, called the progressive artificial pancreas. The new device is slim in shape and shows clinical compatibility with the conventional artificial pancreas. We herein review this new closed-loop glycemic control system and the expectations for its future application in critically ill surgical patients.