Control of Blood Sugar in Insulin-Dependent Diabetes: Comparison of an Artificial Endocrine Pancreas, Continuous Subcutaneous Insulin Infusion, and Intensified Conventional Insulin Therapy

We compared the ability of closed-loop intravenous insulin infusion (i.e., an artificial“pancreas”), open-loop continuous subcutaneous insulin infusion, and intensified conventional insulin therapy (preprandial injections of regular insulin, with injection of long-acting zinc-suspension insulin before breakfast) to bring the hyperglycemia of insulindependent diabetic subjects to a level comparable to that of normal, nondiabetic subjects. The mean circadian levels of plasma glucose, mean amplitude of glycemic excursions, and M values (defined in Methods) did not significantly differ among the three regimens. Although these levels in the diabetic subjects approximated those in the normal subjects, the levels of plasma insulin, mean amplitude of glycemic excursions, and M values were significantly higher than those in normal subjects (P<0.01). Therefore, at least on a short-term basis, all three regimens can produce comparable, nearly normal levels of blood sugar in such patients; moreover, closed-loop devices can be used to determine insulin requirements for conventional therapy. (N Engl J Med. 1980; 303:1313–8.) ACCUMULATION of evidence of a relation between hyperglycemia and the microvascular complications of diabetes mellitus¹ has led to efforts to develop new methods to improve metabolic control, since conventional insulin therapy has not been successful in correcting hyperglycemia.² Transplantation of pancreatic tissue has been severely hindered by technical and immunologic problems in human beings³; however, considerable progress has been made in the development of mechanical insulin-delivery systems.⁴ Two classes of devices have evolved: closedloop systems (an artificial“pancreas”), in which the rate of insulin administration is controlled by changes in plasma glucose, and open-loop systems, in which predetermined amounts. . .