The landmark Diabetes Control and Complications Trial published in 1993 found, however, that maintenance of near normal glucose levels reduced the risk of long-term microvascular complications. Diabetes is the leading cause of blindness, kidney disease, and amputation in the United States and Europe. Long-term effects of elevated blood glucose, or hyperglycemia, include a range of microvascular complications including retinopathy, nephropathy, and neuropathy.

In insulin-dependent diabetes, however, β cell function is impaired and the homeostatic equilibration of blood glucose is no longer present. In nondiabetic individuals, the pancreas is able to sense changes in blood glucose and respond by stimulating the release of insulin via the β cells to lower blood glucose or glucagon via the α cells to increase blood glucose. Glucose homeostasis in humans is a superb example of closed-loop regulation of a vital physiological parameter. With these advances, an artificial or bionic pancreas is within reach. The advent of modern smartphones has created the ability to utilize smartphone technology as the engineering centerpiece of an artificial pancreas. Advances in artificial pancreas research in the first decade of this century were based on the ongoing computer revolution and miniaturization of electronic technology. There are several major strategies for the design of control algorithms and supervision control for application to the artificial pancreas: proportional–integral–derivative, model predictive control, fuzzy logic, and safety supervision designs. The bihormonal approach uses both insulin to lower blood glucose and glucagon to raise blood glucose, and also relies on complex algorithms to provide for safety of the user. The unihormonal approach uses insulin to reduce blood glucose and relies on complex safety mitigation algorithms to reduce the risk of hypoglycemia. There are two major system-level approaches to achieving closed-loop control of blood glucose in diabetic individuals.

This review discusses progress in the development of external systems that are based on subcutaneous drug delivery and subcutaneous continuous glucose monitoring. Recent advances in insulins, insulin pumps, continuous glucose-monitoring systems, and control algorithms have resulted in an acceleration of progress in the development of artificial pancreas devices.

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