Artificial pancreas: the past and the future.

In glucose management using continuous insulin infusion, artificial pancreas systems prevent blood glucose fluctuations and severe hypoglycemia using insulin pumps and continuous glucose monitoring. Advances in both insulin pumps and continuous glucose monitoring have enabled the transition from sensor augmented pump therapy, where insulin delivery is manually adjusted, to hybrid closed-loop insulin pump therapy, which automatically adjusts basal insulin infusion. Furthermore, fully automated insulin delivery systems that adjust insulin based on variations due to meals and exercise are now possible. These systems have been primarily applied to patients with type 1 diabetes but are now expanding to all insulin-dependent patients. Wearable artificial pancreas systems measure glucose levels in subcutaneous tissue fluid, while bedside artificial pancreas systems measure glucose levels in venous blood, making them suitable for managing the highly variable blood glucose levels of perioperative and critically ill patients. Future developments are anticipated to integrate the benefits of both wearable and bedside systems.