Dual-hormone artificial pancreas for management of type 1 diabetes: Recent progress and future directions

Marco Infante, David A. Baidal, Michael R. Rickels, Andrea Fabbri, Jay S. Skyler, Rodolfo Alejandro, Camillo Ricordi

Research output: Contribution to journalReview articlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)968-986
Number of pages19
JournalArtificial Organs
Issue number9
StatePublished - Sep 2021
Externally publishedYes


  • T1D
  • amylin
  • closed-loop control
  • dual-hormone artificial pancreas
  • glucagon
  • multihormone artificial pancreas
  • pramlintide
  • triple-hormone artificial pancreas
  • type 1 diabetes
  • ultra-rapid insulin

ASJC Scopus subject areas

  • Bioengineering
  • Medicine (miscellaneous)
  • Biomaterials
  • Biomedical Engineering


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