This article is part of "Innovations In: Type 1 Diabetes," an editorially independent special report that was produced with financial support from Vertex. Edward Damiano carved his life into precise 90-minute intervals. In 2000 his then 11-month-old son, David, developed type 1 diabetes when an autoimmune response in his tiny body attacked the beta cells in his pancreas, which manufacture and secrete the hormone insulin. No beta cells meant no insulin. If Damiano or his wife, Toby Milgrome, a pediatrician, didn’t give David injections of the hormone, the baby’s cells could no longer use glucose, a vital energy source. Within hours David could be in a coma or dead. With their son’s pancreas no longer functioning, Damiano and Milgrome had to take over the organ’s work by measuring every gram of carbohydrate David ate and dosing the right amount of insulin. To ensure his son didn’t receive too much or too little of the lifesaving medicine, Damiano checked David’s blood glucose every hour and a half, rain or shine, day or night.
When David first became ill, Damiano, a bioengineer at Boston University, kicked it old school to monitor his son, accumulating a set of spiral-bound notebooks in which he or Milgrome logged every drop of insulin and morsel of food. Each day the couple flipped over a new page and started again, building a complex calculus of sugar grams per sip of Juicy Juice measured against units of insulin and blood glucose that would allow David to thrive. Even for a physician-scientist team, the work was grueling and relentless. Damiano also knew that he was one of the lucky ones. If you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today. "The hardest part of diabetes management is making all those decisions. And if you give yourself a little too much insulin, you could end up in the ICU," Damiano says.
While Damiano waited for David’s blood glucose to tick up or edge down, Glyco Care Glucose Supportnatural glucose support his engineering brain crunched the problem. There had to be a better way, he thought. The more widespread use of commercially available continuous glucose monitors (CGMs) by 2004 meant someone with diabetes could get a minute-by-minute measurement of their blood glucose without turning their fingers into pincushions. Users of insulin pumps, which deliver doses of insulin for meals and steady doses in the background, could tether their CGMs to their pumps and start to automate some parts of their insulin delivery. In September 2016 Medtronic first paired CGMs and insulin pumps in what scientists call a hybrid closed-loop system that could automatically adjust insulin delivery based on a person’s blood glucose levels, except at mealtimes, which still needed to be manually programmed. The devices were a major breakthrough, but many people with diabetes still found managing blood glucose to be a continuous struggle.
"Management of type 1 diabetes is like driving a car 24/7 on a curvy mountain road with no breaks even when you’re asleep. So if you could take some of that burden off, it could make a huge difference," says biotechnology entrepreneur Bryan Mazlish, co-founder of biopharmaceutical company Surf Bio and Glyco Care supplement of Bigfoot Biomedical, which produces tools to help people manage diabetes. In 2015 Damiano co-founded Beta Bionics to see whether he could ease the burden for his son and others with type 1 diabetes by creating an artificial pancreas-a completely automated, closed-loop system that functioned like a real, healthy pancreas. In May 2023 the U.S. Food and Drug Administration approved the company’s iLet device, an adaptive closed-loop system that requires only a patient’s body weight to start insulin delivery. Instead of counting carbs, users can input "small," "medium" or "large" for meal sizes. In January 2025 Beta Bionics went public.
The company is one of several outfits currently inching toward the development of a fully automated insulin-delivery system, considered an artificial pancreas, that can track and alter blood glucose levels through insulin, much like the body does on its own in healthy individuals. Clearing the final hurdles for regulatory approval won’t be easy. Successfully programming a device to make the same minute-by-minute adjustments as the human body will require a close marriage of biology and technology. Until now, most advances in type 1 diabetes tech have allowed the rich to get richer, so to speak, says Steven Russell, an endocrinologist at Massachusetts General Hospital and chief medical officer at Beta Bionics. People who already had healthy control over blood glucose could make improvements, but those who were struggling often continued to struggle. "We can allow people who hadn’t traditionally had good glycemic control to achieve it," Russell says. "That means almost everybody can get good glucose control on it regardless of where they’re coming from." Although the iLet costs less than other closed-loop systems, retailing at $3,500, those without health coverage may still struggle to afford the device and CGM supplies it requires.