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The What, Why and How of Automated Insulin Delivery

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A quick guide to understanding the basics of automated insulin delivery (AID) devices for healthcare practioners and users 

Authors: Cowritten by ADCES staff and subject matter expert faculty with support from Insulet Corporation

December 2022

What is AID?

AID systems contain 3 components: A continuous glucose monitor (CGM), an insulin pump, and an algorithm, that makes automatic adjustments to the pump’s insulin delivery in response to the CGM value and trend. These systems are frequently referred to as hybrid or advanced hybrid closed-loop insulin pumps because they are not fully automated and still require input from the user to manually deliver insulin doses when carbohydrate is consumed. (7, 10)

Why AID?

People with diabetes (PWD) who utilize intensive insulin therapy still struggle with elevated A1c, hypoglycemia and glucose variability because there are countless factors that impact glucose values. AID systems are designed to help users achieve increased time in range while minimizing hypoglycemia and reducing the burden of diabetes.

PROVIDER PERSPECTIVES:

WHAT ARE THE LONG-TERM ADVANTAGES OF AID SYSTEMS?

  • Fewer and less severe episodes of hypoglycemia and hyperglycemia
  • Less worry by reducing the risk of hypoglycemia
  • Increased confidence due to more time in target range
  • Potential for improved A1C
  • Stable overnight glucose and increasing the potential for fasting glucose to remain within target
  • Improved sleep due to more stable glucose readings overnight
  • Reductions in diabetes distress - allowing the individual to not have to THINK about their diabetes self-management ALL the time
  • Allows for more “forgiveness” surrounding meals – if someone cannot count carbs precisely, the pump can compensate by increasing the insulin (basal and/or bolus) based on the glucose readings (11)
  • The ability to match basal needs more physiologically instead of presuming someone’s basal requirements are the same day after day
  • Reduces the daily tasks required to manage glucose readings

WHAT ARE CONSIDERATIONS FOR USE OF AID SYSTEMS?

With any technology, it’s important to manage expectations and the realities of using it initially and on a continual basis to individualize and match to the user’s needs. Here are some common considerations to discuss prior to initiating an AID system to set realistic expectations.
  • Two devices must be worn – the insulin pump and CGM
  • Insurance coverage may vary
  • There may be additional alarms/alerts
  • Basal and bolus settings must be assessed prior to initiating
  • Requires a back-up plan in the event of a pump failure
  • User must still pre-bolus for food and adjust for exercise, stress, or illness
  • Time must be allowed for the system to adjust to the user’s needs to get desired results
  • Requires user to troubleshoot when readings are unexpected or out of range
  • Requires trust by allowing the system to make the necessary adjustments without inputting fictitious information

HOW CAN AID HELP THE USER IMPROVE THEIR SELF-MANAGEMENT?

Below is a summary of learnings and best practices related to use of AID systems

and diabetes self-management activities.

Treating Hypoglycemia and Hyperglycemia

Covering Meals and Snacks

Reverting to Open Loop/Manual Mode

Managing Physical Activity

System Options

Below is a comparison of AID systems and some of their key features. For more information on all the specifications, refer to the manufacturers’ user guides (links below).

Learn More About Automated Insulin Pumps

Find and Compare Pumps

CGM and Pump Affordability Programs

Device Training: Omnipod 5 AID System: Continued Advancement in Tubeless Insulin Delivery

 

References:

1. https://www.omnipod.com/current-podders/resources/omnipod-5. Accessed July 1, 2022.
2. https://support.tandemdiabetes.com/hc/en-us/articles/1500011388262-Where-can-I-find-
the-User-Guide-for-my-t-slim-X2-pump-
3. https://www.medtronicdiabetes.com/download-library/minimed-770g-system
4. https://medtronicdiabetes.com/sites/default/files/library/download-library/workbooks/
Top_CGM_Tips.pdf
5. Addala, Al, et al. Cost considerations for adoption of diabetes technology are pervasive: A qualitative study of persons living with type 1 diabetes and their families. Diabetic Medicine, published online April 1, 2021. https://doi.org/10.1111/dme.14575
6. Aiello, E.M., et al. Review of automated insulin delivery systems for individuals with type 1 diabetes: Tailored solutions for subpopulations. Science Direct, published online June 18, 2021.https://doi.org/10.1016/j.cobme.2021.100312
7. Berget, Cari, et. al. Clinical Implementation of the Omipod 5 Automated Insulin Delivery System: Key Considerations for Training and Onboarding People with Diabetes. Clin Diabetes 2022; 40(2): 168-184. https://doi.org/10.2337/cd21-0083
8. Choi M, et al. Do-It-Yourself Open Artificial Pancreas System in Children and Adolescents with Type 1 Diabetes Mellitus: Real-World Data. Diabetes Metab J Published online Nov 23, 2021.https://doi.org/10.4093/dmj.2021.0011
9. Dove K, et al. Closed-loop glucose control in young people with type 1 diabetes during and after unannounced physical activity: a randomized controlled crossover trial. Diabetologia (2017) 60:2157–2167.DOI 10.1007/s00125-017-4395-z.
10. Klonoff DC, Shang T, Zhang J. Automated Insulin Dosing Systems or Automated Insulin Delivery Systems? It is Time for Consistency. Journal of Diabetes Science and Technology. 2021;15(2):211-213.
11. Lewis, D.M., Hussain, S. Practical Guidance on Open Source and Commercial Automated Insulin Delivery Systems: A Guide for Healthcare Professionals Supporting People with Insulin-Requiring Diabetes. Diabetes Ther 13, 1683–1699 (2022). https://doi.org/10.1007/s13300-022-01299-9Diabetes Ther (2022) 13:1683–1699
12. Paldus B, et al. A Randomized Crossover Trial Comparing Glucose Control During Moderate-Intensity, High-Intensity, and Resistance Exercise With Hybrid Closed-Loop Insulin Delivery While Profiling Potential Additional Signals in Adults With Type 1 Diabetes. Diabetes Care, published online November 17, 2021. https://doi.org/10.2337/
13. Panther Program Web Site. https://www.bdcpantherdiabetes.org/device-comparison.
Accessed March 31, 2022.
14. Pinsker J, et al. Predictive Low-Glucose Suspend Necessitates Less Carbohydrate Supplementation to Rescue Hypoglycemia: Need to Revisit Current Hypoglycemia Treatment Guidelines. Diab Tech & Ther. 23:7, 2021. DOI: 10.1089/dia.2020.0619.
15. Ware, J, et al. Recent advanced in closed-loop insulin delivery. Metabolism: Clinical and Experimental, published online December 7, 2021. https://doi.org/10.1016/j.metabol.2021

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This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your diabetes care and education specialist or health care provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. To find a diabetes care and education specialist near you, visit the ADCES finder tool.

ADCES and danatech curate product specifics and periodically review them for accuracy and relevance. As a result, the information may or may not be the most recent. We recommend visiting the manufacturer's website for the latest details if you have any questions.

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