Open-source automated insulin delivery (AID) systems offer customizable, user-driven alternatives to commercial hybrid closed-loop technologies. For DCESs, familiarity with these systems is essential, as more patients are adopting them to access advanced features not yet available in FDA-approved options. While clinicians do not prescribe these systems, understanding their capabilities helps us better interpret patient data, provide safety guidance, and support patient autonomy. The three supported Open-Source options are loop, Android APS, and Trio. Since these systems are open source, they are always being updated and refined. Below are some of the standout features associated with each.

Advanced System Features

Open-source automated insulin delivery (AID) systems are reshaping diabetes care, offering customizable, user-driven alternatives to commercial hybrid closed-loop technologies. For Diabetes Care and Education Specialists (DCESs), staying informed on these systems is essential as more people adopt them for features not yet available in FDA-approved devices. While clinicians do not prescribe open-source systems, understanding their functionality helps providers interpret data, guide safe use, and support patient autonomy. The three primary platforms in use today are Loop, AndroidAPS, and Trio, each offering unique capabilities that evolve continuously as their communities update and refine them.

Advanced System Features

Loop (iOS-Based)

Loop integrates seamlessly with Nightscout, allowing caregivers and clinicians to view real-time glucose and insulin data and even override presets. Users can create custom overrides—temporary adjustments to insulin needs and glucose targets—that prove useful for exercise, illness, stress, high-fat meals, or other situations affecting glucose control. Loop also allows fine-tuned algorithm adjustments, including carb absorption times and individualized glucose targets, giving patients more flexibility than commercial closed-loop systems. Its third-party integrations, such as Apple Shortcuts, further automate routines like activating an exercise override when a workout is logged.

AndroidAPS (Android-Based)

AndroidAPS offers some of the most advanced automation features. Parents and caregivers can remotely bolus and monitor data, while users benefit from flexible algorithms like Super Micro Boluses (SMB) and dynamic insulin-on-board calculations for tighter control. The system is built with safety layers, including configurable maximum bolus and basal settings and customizable hypoglycemia-prevention logic. Experienced users can further customize routines through automations and scripting, tailoring insulin delivery for exercise, circadian rhythms, or predictable daily events.

Trio (iOS-Based)

Trio emphasizes simplicity without sacrificing power. It supports remote access for caregivers and clinicians and includes automated carb and correction entries, reducing the burden of frequent manual inputs. With its unannounced meal feature (UAM) and custom target adjustments, Trio enables users to maintain flexibility without the steep learning curve often associated with AndroidAPS. Its evolving design philosophy focuses on lowering barriers to entry while still offering meaningful automation.

The Role of HCPs and other HCPs

For DCESs and other HCPs, supporting patients who use open-source AID requires a balance of technical understanding and clinical judgment. Providers should recognize that patients may use remote bolusing, overrides, or advanced safety features that differ from commercial systems. It’s critical to:

• Support patients in safely configuring insulin sensitivity factors, carb ratios, and basal profiles.
• Reinforce the importance of backup plans in case of device or connectivity failure.
• Understand how features like remote monitoring and delegated boluses affect pediatric or caregiver-managed care.
• Facilitate shared decision-making that respects patient-driven customization while emphasizing safe insulin use.

Practice Pearls from the Diabetes Care and Education Specialists

• Expect differences in configuration across systems.
• Evaluate advanced settings (e.g., SMBs, temporary targets) within the context of the patient’s overall lifestyle and glycemic profile.
• Encourage patients to maintain redundancy and manual backup dosing strategies.
• Stay aware of the implications of remote bolusing, particularly in pediatrics.
• Leverage Nightscout or other data platforms to review reports in a format familiar to both patients and HCPs.

Staying Informed

Because open-source platforms evolve rapidly, DCESs benefit from engaging with educational and peer-driven resources. Reliable documentation can be found in LoopDocs, AndroidAPS Documentation, and TrioDocs, while communities such as Loop and Learn provide newsletters, tutorials, and troubleshooting guides. Video tutorials on the Loop and Learn YouTube channel, as well as support networks through Facebook groups, Zulip, Discord, and other forums, offer real-world insights into system use and safety.

Why This Matters

These platforms are not only advancing technical features but also shaping how patients and caregivers engage with diabetes care. By understanding both the capabilities and limitations of open-source AID systems, DCESs can provide safer, more informed guidance, empowering individuals to optimize their glycemic control while maintaining autonomy.

For all HCP’s we recommend subscribing to the Loop and Learn newsletters. These are well organized emails sent out that include all important updates, educational points and more.

Documentation & Learning Hubs

• Trio Documentation – In-depth information on setup, functionality, and algorithms for the Trio system
  
• LoopDocs – Comprehensive technical and user guide for Loop, including remote build, Nightscout integration, and advanced tuning
  
• Loop and Learn – Community-driven tutorial site with PDFs, how-tos, and troubleshooting write-ups
  
• AndroidAPS Documentation – Covers core features, getting started, remote control, automations, and advanced configurations
• NightScout - Nightscout (also known as CGM in the Cloud) is an open-source cloud application used by people with diabetes and parents of kids with diabetes to visualize, store and share the data from their Continuous Glucose Monitoring sensors in real-time.
  

Video Tutorials & Webinars

●     Loop and Learn YouTube Channel – Archive of instructional videos, webinars, and practical tutorials on Loop usage (YouTube)

Community Support & Social Media Spaces

Facebook Communities

• Loop and Learn – Peer support for building, operating, and troubleshooting Loop (loopnlearn.org)
  
• The Looped Group – Covers all open-source AID systems including Loop, AndroidAPS, and OpenAPS (loopnlearn.org)
  
• AndroidAPS Users – Dedicated to AndroidAPS setup and help (Facebook)
  
• Trio: DIY Diabetes App Support – Support hub for the Trio app (search via Facebook) (loopandlearn.org)
  
  

Developer Chats & Support Platforms:

• Loop Zulip Chat – Hosted in LoopDocs, ideal for technical questions and developer interaction (loopkit.github.io)
  
• AndroidAPS Discord – Join via links shared by the AndroidAPS community (refer to documentation) (androidaps.readthedocs.io)
  
• Trio Discord – Community-support channel linked on Trio documentation and Nightscout-related community pages (loopandlearn.org)
  
  

Why These Matter 

These platforms are where patients and their caregivers exchange real-world experiences, troubleshoot issues, and share advanced configurations. Familiarity with these resources will help DCESs stay informed on evolving features, safety discussions, and support trends emerging from the open-source AID communities.