ABSTRACT
Diabetes is a chronic disease, which currently can be controlled only by constant vigilance. Chronic elevations, and likely fluctuations, of the blood glucose are associated with long-term complications (blindness, kidney failure, heart disease, and lower extremity amputations). Perversely, tight glucose control increases the risk of serious hypoglycemia. Despite insulin infusion pumps and programs that promote intensive diabetes management, the average A1c at major diabetes treatment centers remains higher than 8% (1), which is well above the recommended goal of 7% for adults and for age-adjusted pediatric goals (Table 1). Many factors contribute to this failure: (i) the difficulties in correctly estimating the amount of carbohydrates in a meal, (ii) missed meal boluses, and (iii) anxiety about hypoglycemia resulting in undertreatment, especially overnight. It has always been difficult to achieve compliance with complicated medical regimes, whether it is taking pills three or four times a day or administration of insulin three or more times a day. As long as diabetes treatment demands constant direct intervention, the vast majority of people with diabetes will not meet treatment goals. By taking the patient out of the loop or closing the loop, an “artificial pancreas” would allow the person with diabetes to go about their daily activities without the need to
Table 1 Hemoglobin A1c Goals by Age
Target range Age (yr) (mg/dL) HbA1c 0-5 80-200 7.5-8.5% 6-11 70-180 Less than 8% 12-20+ 70-150 Less than 7%
constantly remember to check their blood glucose, count carbohydrates, and take insulin multiple times each day.
