Automated Insulin Delivery: We’ve Come So Far, Yet Have So Far to Go
Apr 25, 2022, 13:48 PM
By Carla Cox, PhD, RDN, CDCES, FADCES
In September 2016, the first hybrid closed-loop pump was FDA approved. Most of us remember the date well, and the enthusiasm it brought. Since that time, there have been improvements in the original 670G system (now 770G) along with FDA approval for the Tandem control IQ automated insulin delivery system and now the Omnipod 5. These are available to our patients in addition to the non-FDA approved open-source systems (also known as DIY) that over 10,000 persons worldwide are now using.
Doctors Gregory Forlenza and Reyhan Lal are two experts in the field of automated insulin delivery (AID) and recently wrote an article for Diabetes Technology and Therapeutics that provides the current state and emerging options for insulin delivery systems. The study designs are discussed for each of the systems, clarifying which systems have been studied in a more controlled vs. real-world environment. In addition, and most importantly, how the system works and what options there are for modifying the system. For example, the Medtronic 770G can have the carb ratio and active insulin time modified, whereas the control IQ can have basal rates, correction factors and insulin to carb ratios modified, but not the active insulin time (which is set at 5 hours). The Omnipod 5 will adjust basal rates after the first pod change and reset insulin delivery based on the total daily insulin used without direct provider input. Target glucose values can be edited from the standard setting of 110-150 mg/dl for a more personal choice. The CamAPS FX received the CE (Conformite Europeenne) approval in 2020, but it has not yet been FDA approved in the United States as an AID system.
Other highlights from the article include:
- An excellent chart which reports the trial data on 6 different device pivotal trials to provide a quick comparison of TIR, TBR, TAR etc. metrics.
- A review of the documented challenges and discontinuation of CGM use, along with the potential future of CGM and hopefully at some point, non-invasive systems.
- A quick review of new, more rapid acting insulins for which there have been mixed results from the research.
For anyone working in the field of diabetes pump technologies – this article is a must read! Clear, precise and a wealth of information on the here and now as well as projections for the future of tools to help persons on insulin achieve more time in target with less effort.
Want to learn more about automated insulin delivery? Check out this two-part podcast episode to dive into the basics, benefits and practical considerations of open-source automated insulin delivery.
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The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.
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