Surgical stress induces hyperglycemia and gives rise to glucose toxicity, which causes infectious diseases, resulting in unfavorable surgical outcomes. Intensive insulin treatment can control short- and long-term complications in patients with not only diabetes mellitus, but also surgical diabetes; however, it is associated with an increased risk of hypoglycemia. The wearable artificial pancreas was originally developed to control glucose levels in patients with type 1 diabetes, progressing to a device with enhanced stability and safety for these patients. Its usability has further progressed to include patients with type 2 diabetes. The bedside artificial pancreas is the only closed-loop-type artificial pancreas which can maintain stable glycemic control in accordance with a target blood glucose range, based on the patient’s actual blood glucose levels. Moreover, this stable glycemic control with a low variation in blood glucose concentration within the target range is produced without any hypoglycemia. Significant advances of this device will now occur due to the approval of treatment for perioperative glycemic control by the Japanese Health Care Insurance System in 2016. Along with an increase in the number of mainly elderly patients with low glucose tolerance, it is expected that the role of the artificial pancreas will increase in the future. Considering the current state and expense of regenerative and transplant medicine, along with donor shortages, further development of the artificial pancreas and associated glycemic control can be expected.
Artificial pancreas Wearable artificial pancreas Bedside artificial pancreas Closed-loop system Glycemic control Perioperative management
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Conflict of interest
All authors declared that they have no competing interests.
Hanazaki K, Kitagawa H, Yatabe T, et al. Perioperative intensive insulin therapy using an artificial endocrine pancreas with closed-loop glycemic control system: the effects of no hypoglycemia. Am J Surg. 2014;207:935–41.CrossRefPubMedGoogle Scholar
NICE-SUGAR Study Investigators, Finfer S, Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97.CrossRefGoogle Scholar
Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354:449–61.CrossRefPubMedGoogle Scholar
Hanazaki K, Munekage M, Kitagawa H, et al. Current topics in glycemic control by wearable artificial pancreas or bedside artificial pancreas with closed-loop system. J Artif Organs. 2016;19:209–18.CrossRefPubMedGoogle Scholar
Tsukamoto Y, Kinoshita Y, Kitagawa H, et al. Evaluation of a novel artificial pancreas: closed loop glycemic control system with continuous blood glucose monitoring. Artif Organs. 2013;37:E67–73.CrossRefPubMedGoogle Scholar
Signal M, Thomas F, Shaw GM, et al. Complexity of continuous glucose monitoring data in critically ill patients: continuous glucose monitoring devices, sensor locations, and detrended fluctuation analysis methods. J Diabetes Sci Technol. 2013;7:1492–506.CrossRefPubMedPubMedCentralGoogle Scholar
Phillip M, Battelino T, Atlas E, et al. Nocturnal glucose control with an artificial pancreas at a diabetes camp. N Engl J Med. 2013;368:824–33.CrossRefPubMedGoogle Scholar
Bergenstal RM, Klonoff DC, Garg SK, et al; ASPIRE In-Home Study Group. Threshold-based insulin-pump interruption for reduction of hypoglycemia. N Engl J Med. 2013;369:224–32.CrossRefPubMedGoogle Scholar
El-Khatib FH, Jiang J, Damiano ER. Adaptive closed-loop control provides blood-glucose regulation using dual subcutaneous insulin and glucagon infusion in diabetic Swine. J Diabetes Sci Technol. 2007;1:181–92.CrossRefPubMedPubMedCentralGoogle Scholar
El-Khatib FH, Balliro C, Hillard MA, et al. Home use of a bihormonal bionic pancreas versus insulin pump therapy in adults with type 1 diabetes: a multicentre randomised crossover trial. Lancet. 2017;389:369–80.CrossRefPubMedGoogle Scholar
Bakhtiani PA, Zhao LM, El Youssef J, et al. A review of artificial pancreas technologies with an emphasis on bi-hormonal therapy. Diabetes Obes Metab. 2013;15:1065–70.CrossRefPubMedGoogle Scholar
Bakhtiani PA, Caputo N, Castle JR, et al. A novel, stable, aqueous glucagon formulation using ferulic acid as an excipient. J Diabetes Sci Technol. 2015;9:17–23.CrossRefPubMedGoogle Scholar
Kono T, Hanazaki K, Yazawa K, et al. Pancreatic polypeptide administration reduces insulin requirements of artificial pancreas in pancreatectomized dogs. Artif Organs. 2005;29:83–7.CrossRefPubMedGoogle Scholar
Namikawa T, Munekage M, Kitagawa H, et al. Comparison between a novel and conventional artificial pancreas for perioperative glycemic control using a closed-loop system. J Artif Organs. 2017;20:84–90.CrossRefPubMedGoogle Scholar
Munekage M, Yatabe T, Sakaguchi M, et al. Comparison of subcutaneous and intravenous continuous glucose monitoring accuracy in an operating room and an intensive care unit. J Artif Organs. 2016;19:159–66.CrossRefPubMedGoogle Scholar
Munekage M, Yatabe T, Kitagawa H, et al. An artificial pancreas provided a novel model of blood glucose level variability in beagles. J Artif Organs. 2015;18:387–90.CrossRefPubMedGoogle Scholar
Kitagawa H, Yatabe T, Namikawa T, et al. Postoperative closed-loop glycemic control using an artificial pancreas in patients after esophagectomy. Anticancer Res. 2016;36:4063–7.CrossRefPubMedGoogle Scholar
Kotagal M, Symons RG, Hirsch IB, et al. SCOAP-CERTAIN Collaborative. Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Ann Surg. 2015;261:97–103.CrossRefPubMedPubMedCentralGoogle Scholar