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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).