Diabetes Technology: Markers, Monitoring, Assessment, and Control of Blood Glucose Fluctuations in Diabetes

People with diabetes face a life-long optimization problem: to maintain strict glycemic control without increasing their risk for hypoglycemia. Since the discovery of insulin in 1921, the external regulation of diabetes by engineering means has became a hallmark of this optimization. Diabetes technology has progressed remarkably over the past 50 years—a progress that includes the development of markers for diabetes control, sophisticated monitoring techniques, mathematical models, assessment procedures, and control algorithms. Continuous glucose monitoring (CGM) was introduced in 1999 and has evolved from means for retroactive review of blood glucose profiles to versatile reliable devices, which monitor the course of glucose fluctuations in real time and provide interactive feedback to the patient. Technology integrating CGM with insulin pumps is now available, opening the field for automated closed-loop control, known as the artificial pancreas. Following a number of in-clinic trials, the quest for a wearable ambulatory artificial pancreas is under way, with a first prototype tested in outpatient setting during the past year. This paper discusses key milestones of diabetes technology development, focusing on the progress in the past 10 years and on the artificial pancreas—still not a cure, but arguably the most promising treatment of diabetes to date.