Over the last few years, technological advances have led to tremendous improvement in the management of
type 1 diabetes (T1D).
Artificial pancreas systems have been shown to improve
glucose control compared with conventional
insulin pump
therapy. However, clinically significant
hypoglycemic and hyperglycemic episodes still occur with the
artificial pancreas. Postprandial
glucose excursions and exercise-induced
hypoglycemia represent major hurdles in improving
glucose control and
glucose variability in many patients with T1D. In this regard, dual-
hormone artificial pancreas systems delivering other
hormones in addition to
insulin (
glucagon or
amylin) may better reproduce the physiology of the endocrine pancreas and have been suggested as an alternative tool to overcome these limitations in clinical practice. In addition, novel ultra-
rapid-acting insulin analogs with a more physiological time-action profile are currently under investigation for use in
artificial pancreas devices, aiming to address the unmet need for further improvements in postprandial
glucose control. This review article aims to discuss the current progress and future outlook in the development of novel ultra-rapid
insulin analogs and dual-
hormone closed-loop systems, which offer the next steps to fully closing the loop in the
artificial pancreas.