Current State of Automated Insulin Delivery Options For Diabetes Management: A Primer For The Clinician
DOI:
https://doi.org/10.69734/92xeed68Keywords:
type 1 diabetes, type 2 diabetes, automated insulin delivery, continous glucose monitor, glucose sensor, hybrid closed loopAbstract
Automated Insulin Delivery (AID) systems, which combine the use of insulin pumps with glucose sensors and software dosing algorithms, have revolutionized the management of diabetes. This review covers the components of AID systems, the benefits and limitations, and where future iterations of AID systems are headed. As these tools become more common place, we review what physicians and clinicians of all types need to know about these systems and how we like to approach using these systems in people with diabetes.
References
Committee ADAPP. 7. Diabetes Technology: Standards of Care in Diabetes—2025. Diabetes Care. 2024;48(Supplement_1):S146-S66 D.O.I: 10.2337/dc25-S007. PMID:
Forlenza GP, Argento NB, Laffel LM. Practical Considerations on the Use of Continuous Glucose Monitoring in Pediatrics and Older Adults and Nonadjunctive Use. Diabetes technology & therapeutics. 2017;19(S3):S13-S20 D.O.I: 10.1089/dia.2017.0034. PMID: 28585878
Beck RW, Riddlesworth T, Ruedy K, Ahmann A, Bergenstal R, Haller S, et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections: The DIAMOND Randomized Clinical Trial. Jama. 2017;317(4):371-8 D.O.I: 10.1001/jama.2016.19975. PMID: 28118453
Sawyer A, Sobczak M, Forlenza GP, Alonso GT. Glycemic Control in Relation to Technology Use in a Single Center Cohort of Children With Type 1 Diabetes. Diabetes technology & therapeutics. 2022 D.O.I: 10.1089/dia.2021.0471. PMID: 35099306
Laffel LM, Kanapka LG, Beck RW, Bergamo K, Clements MA, Criego A, et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Adolescents and Young Adults With Type 1 Diabetes: A Randomized Clinical Trial. Jama. 2020;323(23):2388-96 D.O.I: 10.1001/jama.2020.6940. PMID: 32543683
Garg SK, Weinzimer SA, Tamborlane WV, Buckingham BA, Bode BW, Bailey TS, et al. Glucose Outcomes with the In-Home Use of a Hybrid Closed-Loop Insulin Delivery System in Adolescents and Adults with Type 1 Diabetes. Diabetes technology & therapeutics. 2017;19(3):155-63 D.O.I: 10.1089/dia.2016.0421. PMID: 28134564
Brown SA, Kovatchev BP, Raghinaru D, Lum JW, Buckingham BA, Kudva YC, et al. Six-month randomized, multicenter trial of closed-loop control in type 1 diabetes. N Engl J Med. 2019;381(18):1707-17 D.O.I. PMID:
Tauschmann M, Thabit H, Bally L, Allen JM, Hartnell S, Wilinska ME, et al. Closed-loop insulin delivery in suboptimally controlled type 1 diabetes: a multicentre, 12-week randomised trial. Lancet. 2018;392(10155):1321-9 D.O.I. PMID:
Bergenstal RM, Garg S, Weinzimer SA, Buckingham BA, Bode BW, Tamborlane WV, et al. Safety of a hybrid closed-loop insulin delivery system in patients with type 1 diabetes. Jama. 2016;316(13):1407-8 D.O.I. PMID:
Leelarathna L, Choudhary P, Wilmot EG, Lumb A, Street T, Kar P, et al. Hybrid closed‐loop therapy: Where are we in 2021? Diabetes, Obesity and Metabolism. 2021;23(3):655-60 D.O.I. PMID:
Boughton CK, Hovorka R. New closed-loop insulin systems. Diabetologia. 2021;64(5):1007-15 D.O.I. PMID:
Kudva YC, Laffel LM, Brown SA, Raghinaru D, Pinsker JE, Ekhlaspour L, et al. Patient-Reported Outcomes in a Randomized Trial of Closed-Loop Control: The Pivotal International Diabetes Closed-Loop Trial. Diabetes technology & therapeutics. 2021;23(10):673-83 D.O.I: 10.1089/dia.2021.0089. PMID: 34115959
Sherr JL, Schoelwer M, Dos Santos TJ, Reddy L, Biester T, Galderisi A, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Insulin delivery. Pediatr Diabetes. 2022;23(8):1406-31 D.O.I: 10.1111/pedi.13421. PMID: 36468192
Sherr JL, Heinemann L, Fleming GA, Bergenstal RM, Bruttomesso D, Hanaire H, et al. Automated Insulin Delivery: Benefits, Challenges, and Recommendations. A Consensus Report of the Joint Diabetes Technology Working Group of the European Association for the Study of Diabetes and the American Diabetes Association. Diabetes Care. 2022 D.O.I: 10.2337/dci22-0018. PMID: 36202061
Sequel’s twiist™ Automated Insulin Delivery System Receives FDA 510(k) Clearance 2024 [Available from: https://www.biospace.com/article/releases/sequel-s-twiist-automated-insulin-delivery-system-receives-fda-510-k-clearance/.
Cambridge Uo. US FDA approves Cambridge-developed artificial pancreas 2024 [Available from: https://www.cam.ac.uk/research/news/us-food-and-drug-administration-approves-cambridge-developed-artificial-pancreas.
New Simplera Sync™ sensor for the MiniMed™ 780G System now FDA approved 2025 [Available from: https://news.medtronic.com/2025-04-18-New-Simplera-Sync-TM-sensor-for-the-MiniMed-TM-780G-System-now-FDA-approved.
Abbott. Abbott Enters Global Partnership to Connect Its World-Leading Continuous Glucose Monitoring System with Medtronic's Insulin Delivery Devices 2024 [Available from: https://abbott.mediaroom.com/2024-08-07-Abbott-Enters-Global-Partnership-to-Connect-Its-World-Leading-Continuous-Glucose-Monitoring-System-with-Medtronics-Insulin-Delivery-Devices.
Senseonics. Eversense CGM System Receives iCGM Designation by the US FDA 2024 [updated April 30, 2024. Available from: https://www.senseonics.com/investor-relations/news-releases/2024/04-30-2024-120116563#:~:text=The%20companies%20plan%20to%20advance%20partnership%20discussions,of%20Diabetes%20and%20the%20American%20Diabetes%20Association.
Carlson AL, Sherr JL, Shulman DI, Garg SK, Pop-Busui R, Bode BW, et al. Safety and glycemic outcomes during the MiniMed™ Advanced Hybrid Closed-Loop system pivotal trial in adolescents and adults with type 1 diabetes. Diabetes technology & therapeutics. 2021 D.O.I: 10.1089/dia.2021.0319. PMID: 34694909
Brown SA, Forlenza GP, Bode BW, Pinsker JE, Levy CJ, Criego AB, et al. Multicenter Trial of a Tubeless, On-Body Automated Insulin Delivery System With Customizable Glycemic Targets in Pediatric and Adult Participants With Type 1 Diabetes. Diabetes Care. 2021 D.O.I: 10.2337/dc21-0172. PMID: 34099518
Russell SJ, Beck RW, Damiano ER, El-Khatib FH, Ruedy KJ, Balliro CA, et al. Multicenter, Randomized Trial of a Bionic Pancreas in Type 1 Diabetes. N Engl J Med. 2022;387(13):1161-72 D.O.I: 10.1056/NEJMoa2205225. PMID: 36170500
Lum JW, Bailey RJ, Barnes-Lomen V, Naranjo D, Hood KK, Lal RA, et al. A Real-World Prospective Study of the Safety and Effectiveness of the Loop Open Source Automated Insulin Delivery System. Diabetes technology & therapeutics. 2021;23(5):367-75 D.O.I: 10.1089/dia.2020.0535. PMID: 33226840
Committee ADAPP. 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2025. Diabetes Care. 2024;48(Supplement_1):S128-S45 D.O.I: 10.2337/dc25-S006. PMID:
Silva JD, Lepore G, Battelino T, Arrieta A, Castañeda J, Grossman B, et al. Real-World Performance of the MiniMed™ 780G System: First Report of Outcomes from 4120 Users. Diabetes technology & therapeutics. 2022;24(2):113-9 D.O.I: 10.1089/dia.2021.0203. PMID: 34524003
Breton MD, Kovatchev BP. One Year Real-World Use of the Control-IQ Advanced Hybrid Closed-Loop Technology. Diabetes technology & therapeutics. 2021 D.O.I: 10.1089/dia.2021.0097. PMID: 33784196
Forlenza GP, DeSalvo DJ, Aleppo G, Wilmot EG, Berget C, Huyett LM, et al. Real-World Evidence of Omnipod(®) 5 Automated Insulin Delivery System Use in 69,902 People with Type 1 Diabetes. Diabetes technology & therapeutics. 2024;26(8):514-25 D.O.I: 10.1089/dia.2023.0578. PMID: 38375861
Alwan H, Wilinska ME, Ruan Y, Da Silva J, Hovorka R. Real-World Evidence Analysis of a Hybrid Closed-Loop System. Journal of diabetes science and technology. 2023:19322968231185348 D.O.I: 10.1177/19322968231185348. PMID: 37421250
Davis GM, Peters AL, Bode BW, Carlson AL, Dumais B, Vienneau TE, et al. Glycaemic outcomes in adults with type 2 diabetes over 34 weeks with the Omnipod® 5 Automated Insulin Delivery System. Diabetes, obesity & metabolism. 2025;27(1):143-54 D.O.I: 10.1111/dom.15993. PMID: 39382001
Kudva YC, Raghinaru D, Lum JW, Graham TE, Liljenquist D, Spanakis EK, et al. A Randomized Trial of Automated Insulin Delivery in Type 2 Diabetes. N Engl J Med. 2025 D.O.I: 10.1056/NEJMoa2415948. PMID: 40105270
Ozaslan B, Deshpande S, Doyle FJ, 3rd, Dassau E. Zone-MPC Automated Insulin Delivery Algorithm Tuned for Pregnancy Complicated by Type 1 Diabetes. Front Endocrinol (Lausanne). 2021;12:768639 D.O.I: 10.3389/fendo.2021.768639. PMID: 35392357
Committee ADAPP. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2025. Diabetes Care. 2024;48(Supplement_1):S306-S20 D.O.I: 10.2337/dc25-S015. PMID:
Ebekozien O, Mungmode A, Sanchez J, Rompicherla S, Demeterco-Berggren C, Weinstock RS, et al. Longitudinal Trends in Glycemic Outcomes and Technology Use for Over 48,000 People with Type 1 Diabetes (2016-2022) from the T1D Exchange Quality Improvement Collaborative. Diabetes technology & therapeutics. 2023;25(11):765-73 D.O.I: 10.1089/dia.2023.0320. PMID: 37768677
Wang M, Singh LG, Spanakis EK. Advancing the Use of CGM Devices in a Non-ICU Setting. Journal of diabetes science and technology. 2019;13(4):674-81 D.O.I: 10.1177/1932296818821094. PMID: 30636449
Baysal N, Cameron F, Buckingham BA, Wilson DM, Chase HP, Maahs DM, et al. A novel method to detect pressure-induced sensor attenuations (PISA) in an artificial pancreas. Journal of diabetes science and technology. 2014;8(6):1091-6 D.O.I: 10.1177/1932296814553267. PMID: 25316716
Kovatchev B, Castillo A, Pryor E, Kollar LL, Barnett CL, DeBoer MD, et al. Neural-Net Artificial Pancreas: A Randomized Crossover Trial of a First-in-Class Automated Insulin Delivery Algorithm. Diabetes technology & therapeutics. 2024;26(6):375-82 D.O.I: 10.1089/dia.2023.0469. PMID: 38277161
Kadiyala N, Wilinska ME, Daly AB, Nwokolo M, Lakshman R, Hartnell S, et al. Hypoglycemia and Hyperglycemia According to Type of Diabetes: Observations During Fully Closed-Loop Insulin Delivery in Adults With Type 1 and Type 2 Diabetes. Journal of diabetes science and technology. 2024:19322968241242803 D.O.I: 10.1177/19322968241242803. PMID: 38613227
Boughton CK, Hartnell S, Lakshman R, Nwokolo M, Wilinska ME, Ware J, et al. Fully Closed-Loop Glucose Control Compared With Insulin Pump Therapy With Continuous Glucose Monitoring in Adults With Type 1 Diabetes and Suboptimal Glycemic Control: A Single-Center, Randomized, Crossover Study. Diabetes Care. 2023;46(11):1916-22 D.O.I: 10.2337/dc23-0728. PMID: 37616583
Fully Closed Loop at Home (FCL@Home) [Available from: https://clinicaltrials.gov/study/NCT06041971.
Castellanos LE, Balliro CA, Sherwood JS, Jafri R, Hillard MA, Greaux E, et al. Performance of the Insulin-Only iLet Bionic Pancreas and the Bihormonal iLet Using Dasiglucagon in Adults With Type 1 Diabetes in a Home-Use Setting. Diabetes Care. 2021;44(6):e118-e20 D.O.I: 10.2337/dc20-1086. PMID: 33906916
Haidar A, Tsoukas MA, Bernier-Twardy S, Yale J-F, Rutkowski J, Bossy A, et al. A Novel Dual-Hormone Insulin-and-Pramlintide Artificial Pancreas for Type 1 Diabetes: A Randomized Controlled Crossover Trial. Diabetes Care. 2020;43(3):597-606 D.O.I: 10.2337/dc19-1922. PMID:
Dassau E, Renard E, Place J, Farret A, Pelletier MJ, Lee J, et al. Intraperitoneal insulin delivery provides superior glycaemic regulation to subcutaneous insulin delivery in model predictive control-based fully-automated artificial pancreas in patients with type 1 diabetes: a pilot study. Diabetes, obesity & metabolism. 2017;19(12):1698-705 D.O.I: 10.1111/dom.12999. PMID: 28474383
Wolkowicz KL, Aiello EM, Vargas E, Teymourian H, Tehrani F, Wang J, et al. A review of biomarkers in the context of type 1 diabetes: Biological sensing for enhanced glucose control. Bioeng Transl Med. 2021;6(2):e10201 D.O.I: 10.1002/btm2.10201. PMID: 34027090
DeBoer MD, Chernavvsky DR, Topchyan K, Kovatchev BP, Francis GL, Breton MD. Heart rate informed artificial pancreas system enhances glycemic control during exercise in adolescents with T1D. Pediatr Diabetes. 2016 D.O.I: 10.1111/pedi.12454. PMID: 27734563
Roy A, Grosman B, Benedetti A, Engheta B, Miller D, Laron-Hirsh M, et al. An Automated Insulin Delivery System with Automatic Meal Bolus Based on a Hand-Gesturing Algorithm. Diabetes technology & therapeutics. 2024;26(9):633-43 D.O.I: 10.1089/dia.2023.0529. PMID: 38417017
Schoemaker M, Martensson A, Mader JK, Nørgaard K, Freckmann G, Benhamou P-Y, et al. Combining Glucose Monitoring and Insulin Infusion in an Integrated Device: A Narrative Review of Challenges and Proposed Solutions. Journal of diabetes science and technology. 2023;0(0):19322968231203237 D.O.I: 10.1177/19322968231203237. PMID: 37798963
Oser C, Parascando JA, Kostiuk M, Nagel KE, Oser SM, Huss K, et al. Experiences of People With Type 1 Diabetes Using the iLet Bionic Pancreas in Primary Care: A Qualitative Analysis. Clinical diabetes : a publication of the American Diabetes Association. 2025;43(1):109-22 D.O.I: 10.2337/cd24-0060. PMID: 39829692
Realsen J, Goettle H, Chase HP. Morbidity and mortality of diabetic ketoacidosis with and without insulin pump care. Diabetes technology & therapeutics. 2012;14(12):1149-54 D.O.I: 10.1089/dia.2012.0161. PMID: 23009106
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