J Artif Organs (2003) 6:73–87 © The Japanese Society for Artiﬁcial Organs 2003 REVIEW Jan Maria Wojcicki MS, PhD, DEng Piotr Ladyzynski MS, PhD Toward the improvement of diabetes treatment: recent developments in technical support Received: March 3, 2003 J.M. Wojcicki (*) · P. Ladyzynski Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Trojdena St, 02-109 Warsaw, Poland Tel. +48-22-6582875; Fax +48-22-6597030 e-mail: Jan.Wojcicki@ibib.waw.pl Abstract Diabetes is recognized as one of the most severe health problem in the world. It spares no one, attacking men, women, children, and the elderly. Diabetes is the lead- ing cause of kidney failure, blindness in adults, nervous system damage, and amputations. It is a major risk factor for heart disease, stroke, and birth defects. Diabetes is cur- rently one of the most costly diseases in both human and economic terms. Diabetes is a metabolic disorder resulting from insulin deﬁciency, insulin resistance, or both. There are several possible realizations of the so-called artiﬁcial or bio-artiﬁcial pancreas (AP, BAP), systems which should automatically and efﬁciently substitute for the lost function of the  cells. Any types of AP/BAP are routinely used for the treatment of diabetes. Currently, for ambulatory insu- lin-treated diabetics, only application of intensive therapy can effectively delay the development and progression of the above-mentioned life-threatening late complications of diabetes. Ideal intensive insulin treatment should mimic as closely as possible the secretion of insulin by  cells in healthy people. The crucial factors that determine the efﬁciency of this type of treatment are the effective moni- toring of the patient’s glycemic control (monitoring phase) and the accurate delivery of insulin according to established algorithms (treatment phase). The monitoring phase in- cludes blood glucose measurements, the transfer of all parameters measured and noted by the patient to a physician, and clear registration of the data. The treatment phase concerns selection of the optimal insulin regimen and effective insulin delivery to the patient. Delivery of insulin is most commonly realized either intermittently using multiinjection techniques or continuously by portable pumps. However, several others methods of delivery are under development. The main objective of this article is to discuss in detail recent technical developments in intensive insulin treatment, stressing the existing problems and reviewing the best applied solutions. Key words Diabetes · Intensive treatment · Artiﬁcial pancreas Introduction Diabetes is a metabolic disorder resulting from insulin deﬁ- ciency, insulin resistance, or both. It is recognized as one of the most severe health problems in the world. It spares no one, attacking men and women, children and the elderly. Diabetes is a leading cause of renal failure, blindness in adults, nervous system damage, and lower limb amputation. It is a major risk factor for heart disease, stroke, and birth defects. Diabetes shortens the average life expectancy by up to 15 years. It is currently one of the most costly diseases in both human and economic terms. Several different methods that can substitute for the lost function of the  cells in an efﬁcient way have been devel- oped; these include: – Biological approaches to diabetes treatment that are associated with pancreas and islet transplantation – Biotechnical solutions, the so-called hybrid artiﬁcial pancreas, that are associated with application of the micro- and macroencapsulation of the pancreatic islets – Technical support of diabetes treatment that is associated with exogenous insulin delivery aimed to mimic endog- enous insulin secretion in a healthy person. The most advanced technology is currently the electromechanical artiﬁcial pancreas realized as a portable and fully im- plantable closed loop system. Recently, a new concept of closed loop transdermal delivery has been under investigation.