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Type 1 diabetes: from the dream of automated insulin delivery to a fully artificial pancreas

Automated insulin delivery systems have transformed the care of people living with type 1 diabetes and continue to move closer to the ultimate goal of a fully autonomous artificial pancreas.
  1. Moshe Phillip

    1. The Institute for Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

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  2. Aaron Kowalski

    1. JDRF International, New York, NY, USA.

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  3. Tadej Battelino

    1. Faculty of Medicine, University of Ljubljana, and Department of Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.

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The journey from pioneering concept to practical clinical application of automated insulin delivery (AID) systems traces back to 1963, when Arnold Kadish described the first wearable system for delivering insulin, calibrated by an in vivo continuous glucose monitoring (CGM) system (Fig. 1). In effect, this was the first automated closed-loop device, also able to infuse glucagon to counter hypoglycemia. Dubbed ‘The Backpack’, it was an impractical proof-of-concept system that ignited the development of genuinely wearable insulin pumps and CGM systems. By 1974, a portable closed-loop artificial pancreas, which used algorithms on a computer consol to deliver intravenous insulin, was used successfully to treat diabetic ketoacidosis and coma in five adult patients 22–89 years of age1. By 1977, this bulky ‘Biostator’ was in limited use in hospitals. From that point on, the development of diabetes technology focused separately on insulin delivery and CGM systems, rather than on an integrated artificial pancreas. Commercial, wearable, continuous subcutaneous insulin infusion (CSII) pumps were introduced from 1978 onward, and the first ‘smart insulin pump’ was launched in 2002, with a bolus calculator and missed-meal-bolus alarms.

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doi: https://doi.org/10.1038/d41591-024-00013-5

Competing interests

M.P. has participated on advisory boards for AstraZeneca, Eli Lilly, Insulet, Mannkind, Medtronic Diabetes, Pfizer, Sanofi and Dompé, has received consulting fees from Eli Lilly, Medtronic Diabetes, Novo Nordisk, Pfizer, Sanofi and Qulab Medical, has received, through his institute, research grants from Dexcom, Eli Lilly, Insulet, Medtronic Diabetes, Novo Nordisk, Pfizer, Roche Diagnostics, Sanofi, DreaMed Diabetes, NG Solutions, Dompe, Lumos, GWAVE and OPKO, and owns stocks in DreaMed-Diabetes and NG Solutions. T.B. has participated on advisory boards for Novo Nordisk, Sanofi, Eli Lilly, Boehringer-Ingelheim, Medtronic and Indigo Diabete, and as a speaker for AstraZeneca, Eli Lilly, Novo Nordisk, Medtronic, Sanofi and Roche, and owns stocks of DreaMed Diabetes, and his institution has received research grant support and travel expenses from Abbott Diabetes Care, Medtronic, Novo Nordisk, Sanofi, Sandoz and Novartis. A.K. declares no competing interests.

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