Dutch Study: What It's Really Like to Use an Artificial Pancreas

A Study from the Netherlands on Living with a Bihormonal Artificial Pancreas

A study from the Netherlands published in Diabetes Technology & Therapeutics (2026) takes a rare, honest look at what it's actually like to use a bihormonal fully closed-loop system — often called an "artificial pancreas" — in everyday life. Researchers from Radboud University Medical Center in Nijmegen interviewed 12 adults with Type 1 diabetes who had participated in a 12-month real-world trial of this advanced technology.

What Makes This Study Different from US Research?

Most artificial pancreas research — including US studies — focuses on numbers: time in range, A1C reductions, and hypoglycemic episodes. This Dutch team took a different approach, asking patients to describe their lived experiences in their own words. That qualitative perspective is rare and valuable, offering insight into why people stick with the technology or walk away from it. The Netherlands also has a robust universal healthcare system, meaning access barriers that often complicate US studies were largely removed — making the findings more purely about the technology itself.

What Is a Bihormonal Closed-Loop System?

Standard closed-loop systems (like those approved in the US) deliver only insulin automatically based on continuous glucose monitor (CGM) readings. A bihormonal system adds a second hormone — glucagon — to actively raise blood sugar when levels drop too low, rather than just reducing insulin. Think of it as a more complete automated safety net. This technology is still in development and not yet widely available in the US, though research trials are ongoing.

What Did Dutch Patients Actually Experience?

• The good: Most users reported improved blood sugar stability and — importantly — felt "more like a person without diabetes." The psychological relief of reduced constant vigilance was a major benefit.
• The challenges: Users cited hassles around glucagon cartridge replacements, managing multiple device components, and frequent alarms as real burdens.
• The adjustment period: Finding a comfortable working relationship with the system took time and varied widely between individuals. Patience and coping strategies mattered.
• Who stopped and why: The four people who discontinued the system ran into problems early, with frustrations accumulating over time. Notably, discontinuation reasons appeared quickly — suggesting the critical window for support is at the very beginning of use.

How Does This Align with US Guidelines?

Current American Diabetes Association (ADA) guidelines strongly support closed-loop insulin delivery for Type 1 diabetes, emphasizing that diabetes technology works best when paired with education and clinical support. This Dutch study reinforces that message: the hardware alone isn't enough. Expectation management and trained diabetes care teams were identified as essential to long-term success — fully consistent with US best practices.

Why This Matters for US Patients

While bihormonal systems aren't yet widely available in the US, single-hormone closed-loop systems (automated insulin delivery, or AID, systems) are increasingly common. The lessons from this Dutch study apply directly: if you're starting any new diabetes technology, the first weeks are critical. Having a knowledgeable care team and realistic expectations dramatically improves your chances of long-term success. If you're navigating decisions about CGMs, insulin pumps, or other diabetes management tools, the team at MDS Diabetes can help you find options that fit your lifestyle and support your care goals.

Citation

[Netherlands] — Nefs, Jansen, Klaassen (2026). User Experiences of a Bihormonal Fully Closed-Loop System Among Adults with Type 1 Diabetes in a Real-World Setting: A Qualitative Analysis. Diabetes Technology & Therapeutics. PMID: 41055383. DOI: 10.1177/15209156251383522. Institution: Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands.