The Artificial Pancreas: Are We There Yet?

" Are we there yet? " How many parents have heard this phrase time and time again when traveling with young children eager to arrive at a much-anticipated vacation spot, but who are clearly tiring of the travel. The response from the parents is always a reassuring " no, but we are getting very close. " As parents, we then think about how we can use this as a teaching moment to have our children understand that they should enjoy the moment at hand. So, we then reflect on quotes we have heard in the past such as life being a journey, not a destination, and then tell our children they should focus on the travel itself and that getting there is half the fun. We think this is a perfect analogy of the status for closed-loop technology and the artificial pan-creas. But, now, it is not the children asking " are we there yet? " but the parents who can only dream that such a technology will be available for their children with diabetes who have to face the ever-present threat of severe hypoglyce-mia and diabetic ketoacidosis, while struggling to incorporate advances in technology, such as continuous glucose monitoring, into the management of their children's diabetes. This is where many want the " journey " to end and hope we, as a medical community, finally arrive at the " destination, " which is indeed the commercial availability of a truly effective artificial pancreas. There has been remarkable progress made to date in regard to closed-loop technology as the safety and efficacy have been reported in both outpatient and inpatient clinical trials. Given the incredible interest in this topic and its importance to clinical care, this issue of Diabetes Care features a comprehensive selection of articles devoted to the development of the artificial pancreas, including a two-part Bench to Clinic series , two randomized trials, and three additional studies that provide new information on the technology (1–7). We recognize that many readers are somewhat familiar with the concept of an artificial pancreas, but would not be so familiar with all the technologic, al-gorithmic, and physiologic parameters required for such a device or with all the current limitations. In brief, the closed-loop system refers to a feedback-controlled device with an algorithm that automatically adjusts the rate of insulin delivery by an insulin pump based on real-time continuous glucose monitoring data (3). …