A review on the use of adjunctive therapies in artificial pancreas systems

Artificial Pancreas systems facilitate glucose management for people with Type 1 Diabetes (T1D). However, insulin action is sometimes not enough to counteract every disturbance. One approach devoted to improving these systems consists of introducing additional control actions to the system that either act in the opposite direction to insulin or modify the system's dynamics to ease the control task, for instance, by attenuating disturbances, such as meals. The main representative of these systems would be insulin-plus-glucagon strategies. However, recent advances have introduced other hormones, such as pramlintide (an amylin analog), in closed-loop systems. Also, drugs developed for the treatment of Type 2 Diabetes have drawn attention to be used concomitantly with insulin delivery in T1D, such as GLP-1 receptor agonists, SGLT2 inhibitors, Metformin, etc. This work presents a summary of the most representative drugs being researched as adjunctive therapies in T1D and a qualitative review of their presence alongside AP systems. These therapies have diverse effects, and they provide some improvement to the patients' glucose metrics, but they still require further pharmaceutical developments since most present several adverse effects. Copyright (C) 2024 The Authors. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/)