## 1 Introduction  
Successful management of type 1 Diabetes Mellitus (T1 DM) requires that patients learn to plan daily activities such as physical exercise and diet and to measure their glucose levels regularly in order to avoid acute and long-term complications, which produce a high burden on patients' quality of life [1]. Monitoring devices and insulin pumps developed in the last decades with the functionality to continuously measure interstitial glucose and adjust insulin infusion are helpful in improving glucose control clinical outcomes [2,3]. The artificial pancreas (AP) represents the most recent evolution of these devices, aimed at simplifying and improving care for patients with T1 DM. The AP combines a glucose monitoring sensor (which is attached to the arm or abdomen and measures interstitial glucose concentrations), a transmitter that sends these data to an insulin pump and an integrated mathematical algorithm mounted on smartphones or tablets that processes and models continuous glucose monitoring (CGM) data to provide the appropriate insulin infusion based on the glucose levels detected by the sensor. In addition to suspending insulin delivery when glucose levels fall below a predetermined threshold, as in previous devices that integrated CGM and insulin pumps (i.e., sensor-augmented pump) (2,4), the AP also increases insulin dosing when hyperglycemic levels are reached to mimic the functioning of the biological pancreas (5). Single-hormone versions only deliver insulin, whereas dual-hormone versions also include the infusion of glucagon (requiring an additional catheter and infusion pump) (6, 7, 8, 9). Research has shown that AP increases time in the glucose target range and reduces time in hypo- and hyperglycemic levels compared to insulin pump treatment or sensor-augmented pumps (10, 11, 12), although the quality of this evidence is limited due to the short follow-up of studies carried out to date. Compared to single-hormone AP, dual-hormone systems have shown a slightly lower time in hypoglycemia, but no differences in the time in the target range and more gastrointestinal symptoms (13)  
Most versions of currently developed APs are not fully automated closed-loop systems; they still require the patient to provide information on physical activities and meals in order to adjust the insulin infusion (hybrid systems). Despite the benefits mentioned above, studies show that significant durations of hyperglycemia (5-8 h/day above 10 mmol/L [180 mg/dL]) are still reported, particularly after meals (14,15). Therefore, manual adjustments and carbohydrate counting (CC) are still required to calculate insulin doses for each meal. The need for accurate CC can be a barrier for patients, making them feel restrained or anxious or influencing dietary choices in favor or pre-packaged processed foods (16). An alternative to CC in the use of AP is the \"simple meal announcement\" (SMA), whereby the system delivers partial boluses of insulin regardless of the carbohydrate content to be ingested. However, this has resulted in higher levels of postprandial hyperglycemia compared to CC (17). Pramlintide is a synthetic derivative analog of amylin, a hormone released by the beta cells of the pancreas that is co-secreted with insulin after a meal in healthy individuals but is deficient in people with T1 DM (8). Three effects of this hormone are highly relevant to the treatment of diabetes: (1) modulation of gastric emptying, which can be abnormally rapid in diabetes; (2) suppression of glucagon, which is excessively secreted in diabetes, especially after meals; (3) development of satiety shortly after starting to eat. Together with insulin, these effects limit post-meal hyperglycemia and prevent calorie intake (18). Pramlintide is injected with meals because it lowers postprandial glycemia, allowing patients to reduce insulin doses (19, 20, 21). The use of an AP with dual infusion of insulin and pramlintide could represent a helpful resource in the control of postprandial blood glucose levels in complex diabetic patients.