Recent advances in closed-loop insulin delivery

Since the discovery of insulin 100 years ago, we have seen considerable advances across diabetes therapies. The more recent advent of glucose-responsive automated insulin delivery has started to revolutionise the management of type 1 diabetes in children and adults. Evolution of closed-loop insulin delivery from research to clinical practice has been rapid, and multiple systems are now commercially available. In this review, we summarise key evidence on currently available closed-loop systems and those in development. We comment on dual-hormone and do-it-yourself systems, as well as reviewing clinical evidence in special populations such as very young children, older adults and in pregnancy. We identify future directions for research and barriers to closed-loop adoption, including how these might be addressed to ensure equitable access to this novel therapy. •Type 1 diabetes is a lifelong condition with high management burden.•Glucose-responsive automated insulin delivery improves glycaemic outcomes and quality of life.•Multiple closed-loop systems are commercially available, offering increased choice for users.•Working towards a fully closed-loop system and addressing barriers to adoption should be the focus of future research.