Automated Insulin Delivery Systems: Today, Tomorrow and User Requirements

Abstract

Automated insulin delivery (AID) is the most recent advance in type 1 diabetes (T1D) management. It has the potential to achieve glycemic targets without disabling hypoglycemia, to improve quality of life and reduce diabetes distress and burden associated with self-management. Several AID systems are currently licensed for use by people with T1D in Europe, United States, and the rest of the world. Despite AID becoming a reality in routine clinical practice over the last few years, the commercially hybrid AID and other systems, are still far from a fully optimized automated diabetes management tool. Implementation of AID systems requires education and support of healthcare professionals taking care of people with T1D, as well as users and their families. There is much to do to increase usability, portability, convenience and to reduce the burden associated with the use of the systems. Co-design, involvement of people with lived experience of T1D and robust qualitative assessment is critical to improving the real-world use of AID systems, especially for those who may have greater need. In addition to this, information regarding the psychosocial impact of the use of AID systems in real life is needed. The first commercially available AID systems are not the end of the development journey but are the first step in learning how to optimally automate insulin delivery in a way that is equitably accessible and effective for people living with T1D.

ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes education in children and adolescents

“…Structured age‐specific education programs for adults, adolescents, or parents of younger children with T1D on the use of real‐time CGM systems and data interpretation have shown improvements in knowledge, satisfaction, glycemic control, and acceptance of real‐time CGM systems 102–104 . Using automated insulin delivery systems or hybrid‐closed loop systems requires comprehensive education and reeducation of all family members on nutrition and carbohydrate counting, safety behaviors, and an understanding of the integration of these elements into the daily activities of the child/adolescent using the system 105–107 . A key prerequisite for these diabetes technologies is that all team members are appropriately trained and able competently to manage these systems.…”

“… 102 , 103 , 104 Using automated insulin delivery systems or hybrid‐closed loop systems requires comprehensive education and reeducation of all family members on nutrition and carbohydrate counting, safety behaviors, and an understanding of the integration of these elements into the daily activities of the child/adolescent using the system. 105 , 106 , 107 A key prerequisite for these diabetes technologies is that all team members are appropriately trained and able competently to manage these systems.…”