*Disclaimer: This blog is in paid collaboration with Medtronic Diabetes. This blog is meant to provide general information for educational purposes only. The information provided in this blog is not a substitute for medical care and should not replace advice from your healthcare provider.*
Choosing an automated insulin delivery system is a big commitment that requires careful consideration! With numerous automated insulin pumps on the market, making a decision can be overwhelming and stressful.Â
This blog post will guide you through current automated insulin delivery system options and highlight key considerations to assist with finding an option that best fits your lifestyle and individual needs.
What are the advantages of an automated insulin delivery system
Automated insulin delivery (AID) systems, also known as hybrid-closed loop systems, automatically modify insulin delivery in response to detected changes in glucose levels. These systems consist of a continuous glucose monitor (CGM) that identifies glucose levels and sends this information to an insulin pump equipped with an algorithm programmed to regulate insulin delivery. Although users of these systems still need to input some data, advancements in programmed algorithms are reducing the amount of required user-input leading to a more hands off approach to diabetes management. Alongside reducing the burden of diabetes-related decisions, the benefits of automated insulin delivery systems also include:
Reduced frequency and severity of hypoglycemia
By continuously monitoring glucose levels and adjusting insulin doses accordingly, these systems have been shown to decrease the frequency and severity of hypoglycemic episodes.
Less sleep interruptions
Automated insulin delivery systems can reduce sleep interruptions by maintaining glucose levels through automated insulin adjustments. The result of less sleep interruptions throughout the night for insulin pump users or their caregivers can offer a peace of mind and relieve the need of constant vigilance over glucose levels.Â
Improved Time in Range
Automated insulin delivery systems can help improve time in range by adjusting insulin delivery in real-time without the need for user input to decrease the occurrence of both hypo- and hyperglycemia.Â
What are the disadvantages of an automated insulin delivery systems
Automated insulin delivery systems offer a number of significant benefits to people with diabetes, but there are also some disadvantages that users may experience that include:Â
Device malfunctions
Similar to any technological device, automated insulin delivery systems are susceptible to device malfunctions like pump failures or errors. These issues can disrupt insulin delivery and require users to take immediate action to restore insulin delivery and reduce diabetic ketoacidosis risk.
Infusion site issues
Users can encounter problems related to their infusion site such as site infections, occlusions, or dislodgements. When there is an infusion site issue, it can result in insulin delivery that is delayed or ineffective in correcting glucose levels. This is because automated insulin delivery systems algorithms significantly depend on uninterrupted insulin delivery to maintain glucose levels.Â
Learning curve
When transitioning to an AID system, users may experience a learning curve that requires time and patience while adapting to the device functions, interpreting data, and effectively utilizing the algorithm.
Cost
For those seeking an automated insulin delivery system, they require both an insulin pump and continuous glucose monitoring supplies which can increase out-of-pocket medical expenses for people with diabetes.Â
How much does an insulin pump cost
The out-of-pockets cost for an insulin pump depends heavily on an individual’s specific insurance policy. Many people with diabetes can utilize their health insurance benefits for complete or partial coverage for insulin pump supplies to reduce out-of-pocket costs, but coverage amongst policies can vary widely.
For individuals that do not have health insurance coverage, the out-of-pocket costs can range from $4000-8000 or more annually. Patient assistance programs or financial assistance may be available to reduce out of pocket costs for people without or insignificant health insurance coverage.Â
If you are interested in insulin pump therapy, it is best to contact your health insurance provider to see what your out-of-pocket costs are for your specific plan and insulin pump manufacturers.
How to choose an automated insulin delivery system
Whether you are choosing an automated insulin delivery system for the first time or planning on making a switch, you want to take some time to make sure it is a good fit for you. Here are some questions you may want to ask yourself to make the most informed decision:Â
What appeals to you about the pump? (look, features, tubing, tubeless?)
Is the pump compatible with your current CGM?
How does the automated system adjust insulin delivery?
Can you customize settings like basal rates, active insulin time, insulin-to-carb ratios, or correction factors?
Is the pump’s interface user-friendly and easy to navigate?
What infusion set options are available?
What is the maximum amount of insulin the reservoir can hold?
Is there a helpline available 24/7 to troubleshoot issues?
How long is the warranty period?
Automated Insulin Pumps Available in 2024
Medtronic MiniMed™ 780G System
The MiniMed™ 780G system is designed with SmartGuard™ technology, an advanced algorithm that uses current and historical glucose data to provide automatic adjustments and corrections † to sugar levels every 5 minutes § and help cover an occasionally missed meal dose or undercounted carbs.* It is the only system with flexible targets as low as 100 mg/dL‡ for a more customized way to manage diabetes without increasing lows and also provide auto correction boluses to prevent highs.§
* Taking a bolus 15 – 20 minutes before a meal helps to keep blood sugar levels under control after eating.
†Refers to auto correct, which provides bolus assistance. Can deliver all auto correction doses automatically without user interaction, features can be turned on and off.
§ Refers to SmartGuard™ feature. Individual results may vary
.‡ Glucose targets should be chosen following a consultation with your healthcare provider.
Automation Name:Â
SmartGuardâ„¢ technology
Automation Features:Â
Basal Automation:Â Basal automation is calculated from the user's total daily insulin, which is updated each day at midnight and will be adjusted every 5 minutes based on recent glucose trends. Programmed basal rates are not utilized in SmartGuardâ„¢.
Bolus Automation:Â Automated correction boluses can be delivered as often as every 5 minutes if glucose is >120 mg/dL. If the system detects a rise in glucose from a meal, the autocorrection boluses may be stronger. This feature can be turned on or off.Â
Target glucose: Users have the flexibility of choosing personalized glucose targets, based on their healthcare provider’s recommendation, with options including 100, 110 and 120 mg/dL.
Insulin-to-carb ratio: Users can adjust insulin-to-carbohydrate ratios based on their healthcare provider’s recommendation.
Correction Factor: The user programmed correction factor is not used with SmartGuardâ„¢ technology
Active Insulin:Â Users can change active insulin time. Real-world results around the world showed patients achieved an 80% Time in Range with recommended settings of 100 mg/dL and 2-hour active insulin time.Â
Notable Features:Â
The MiniMedâ„¢ 780G system is compatible with the Extendedâ„¢ infusion set that can be worn for up to 7 days, which doubles the wear time compared to other infusion sets on the market.
Insulin reservoir can be swapped independently of infusion set.
Low glucose suspend feature is available when in manual mode.Â
CGM-integration:Â
Medtronic Guardianâ„¢ 3 Sensor
Simplera Sync available in Europe in spring/summer 2024. Investigational. Not approved by the FDA for any use and not commercially available in the US.
Medtronic MiniMedâ„¢ 670G/770G System
Medtronic MiniMedâ„¢ 670G and Medtronic MiniMedâ„¢ 770G Systems feature SmartGuard™ Auto mode that will automatically adjust basal insulin every 5 minutes throughout the day and night.Â
Automation Name:Â
SmartGuard™ Auto mode
Automation Features:Â
Basal Automation:Â Automatically adjusts basal insulin delivery for a target of 120 mg/dL by using CGM glucose value, rate of glucose levels changing and total daily insulin.
Bolus Automation:Â No bolus automation features.
Target glucose: 120 mg/dL
Insulin-to-carb ratio:Â Users have the flexibility to adjust insulin-to-carbohydrate ratios.
Correction Factor: Users can customize insulin sensitivity settings.
Active Insulin:Â Users can select the duration of active insulin time.
Notable Features:Â
Medtronic MiniMedâ„¢ 770G is approved for children ages 2 years and older, while Medtronic MiniMedâ„¢ 670G is approved for children ages 7 years and older.Â
CGM-integration:Â
Tandem Diabetes t:slim x2 with Control IQ
Tandem t:slim x2 with Control IQÂ is an automated insulin delivery system system that will adjust basal insulin rates and deliver correction boluses based on real-time CGM* glucose values. It automatically increases, decreases or suspends basal rates and delivers 60% of calculated correction boluses at a maximum of once per hour to reduce the frequency and severity of hypo- and hyperglycemia.Â
Automation Name:Â
Control IQ
Automation Features:Â
Basal Automation:Â Adjusts programmed basal rates to maintain glucose between 112.5-160 mg/dL. Users can customize their basal profile settings.
Bolus Automation:Â Autocorrection boluses deliver 60% of calculated dose at a maximum of once per hour if glucose is predicted to be >180 mg/dL in 30 minutes.Â
Target glucose: algorithm is set for 112.5-160 mg/dL
Insulin-to-carb ratio:Â Users have the flexibility to adjust insulin-to-carbohydrate ratios.
Correction Factor: Users can customize correction factor settings.
Active Insulin:Â When in Control IQ, active insulin time is fixed at 5 hours.
Notable Features:Â
Users retain the ability to make adjustments to basal rates, insulin-to-carb ratios, and correction factor settings, although active insulin time (set to 5 hours) and correction target glucose (set to 110 mg/dL) cannot be adjusted in Control IQ.
The T:connect Mobile app allows for users to bolus from their compatible smartphone device without directly interacting with their device.
There are a variety of infusion sets available including different insertion angles, cannula materials and tubing lengths.
Control-IQ technology should not be used by anyone under the age of 6 years old and patients requiring less than 10 units of insulin per day or weigh less than 55 pounds.
CGM-integration:Â
Tandem Mobi
Tandem Mobi is the world’s smallest automated insulin delivery device that utilizes Control IQ technology by using values from a compatible CGM sensor to automatically adjust insulin as needed. Unlike t:slim x2, the Mobi does not have a user interface screen Instead, users deliver boluses with their smartphone or by pressing a button located at the base of the pump to deliver a quick bolus.Â
Automation Name:Â
Control IQ
Automation Features:Â
Basal Automation:Â Adjusts programmed basal rates to maintain glucose between 112.5-160 mg/dL. Users can customize their basal profile settings.
Bolus Automation:Â Autocorrection boluses deliver 60% of calculated dose at a maximum of once per hour if glucose is predicted to be >180 mg/dL in 30 minutes.Â
Target glucose: algorithm is set for 112.5-160 mg/dL
Insulin-to-carb ratio:Â Users have the flexibility to adjust insulin-to-carbohydrate ratios.
Correction Factor: Users can customize correction factor settings.
Active Insulin:Â When in Control IQ, active insulin time is fixed at 5 hours.
Notable Features:Â
Users retain the ability to make adjustments to basal rates, insulin-to-carb ratios, and correction factor settings, although active insulin time (set to 5 hours) and correction target glucose (set to 110 mg/dL) cannot be adjusted in Control IQ.
To operate the pump, users rely on their compatible smartphone device since the pump itself does not have an user interface screen. This design choice aims to offer greater discretion for pump users.Â
Users can deliver a quick bolus by pressing a button located at the base of the pump to deliver a quick bolus. An LED status indicator will visually confirm whether the quick bolus was delivered without users having to check their smartphone.
There are a variety of infusion sets available including different insertion angles, cannula materials and tubing lengths.
Control-IQ technology should not be used by anyone under the age of 6 years old and patients requiring less than 10 units of insulin per day or weigh less than 55 pounds.
CGM-integration:Â
Omnipod 5
Omnipod 5Â is a tubeless automated insulin delivery system that utilizes an adaptive basal technology to make real-time adjustments to insulin delivery. With SmartAdjustâ„¢ technology, Omnipod 5 will automatically increase, decrease and pause delivery of insulin based on current and predicted CGM glucose values.
*Fingersticks required for diabetes treatment decisions if symptoms or expectations do not match readings.
§ SmartAdjust™ technology uses a customizable Target Glucose between 110-150 mg/dL, adjustable in 10 mg/dL increments.
Automation Name:Â
SmartAdjustâ„¢ technology/Automated Mode
Automation Features:Â
Basal Automation:Â Omnipod 5 adaptive basal is calculated from total daily insulin, which is updated with each Pod change. Adaptive basal rates adjust every 5 minutes based on a 60 minute prediction of CGM glucose levels, targeting the user's desired glucose value. In automated mode, users do not have any programmed basal rates.
Bolus Automation:Â No automated boluses are delivered, instead the adaptive basal rates are adjusted accordingly.
Target glucose: Users have the flexibility of choosing between 5 target options including: 110, 120, 130, 140, 150 mg/dL and can program different target glucose levels throughout the day.
Insulin-to-carb ratio:Â Users have the flexibility to adjust insulin-to-carbohydrate ratios.
Correction Factor: Users can customize correction factor (insulin sensitivity) settings.
Active Insulin:Â Users can make changes to active insulin time.
Notable Features:Â
Tubeless automated insulin delivery system with a wireless personal controller or a compatible smartphone.Â
Omnipod 5 is approved for children aged 2 and up, making it one of two automated insulin delivery system options approved for this age group. Other AID systems have varying approval ages between 6-16 years old.Â
CGM-integration:Â
iLet Bionic Pancreas System
The iLet Bionic Pancreas System automates all insulin delivery, including basal insulin doses and meal and correction bolus doses. Users are not required to input any insulin therapy settings, the only necessary information needed is their current body weight.
Automation Name:Â
iLet Bionic Pancreas System
Automation Features:Â
Basal Automation: Insulin Automation is started by entering the user's weight, then basal insulin delivery will continue to adjust every 5 minutes based on CGM glucose trends and evolves over time based on the iLet’s analysis of the user’s daily glucose patterns.
Bolus Automation:Â All correction bolus doses are automated.
Target glucose: There are 3 target glucose options: usual, lower and higher. Users can set up to 2 targets throughout the day for more personalized diabetes management.
Insulin-to-carb ratio:Â There are no programmed insulin-to-carbohydrate ratios or carbohydrate counting required. Users can request a meal bolus by entering a meal announcement to specify the meal (breakfast, lunch, or dinner) and the carbohydrates relative to typical intake (usual for more, more than usual, or less than usual). When a meal is announced, the iLet will calculate and deliver a meal bolus dose.
Correction Factor: N/A
Active Insulin:Â N/A
Notable Features:Â
The iLet is designed for automated insulin delivery, requiring minimal user interaction except for meal time announcements.
There is no manual mode option since iLet does not have any programmed pump settings.
Approved for people with type 1 diabetes age 6 years and older.
CGM-integration:Â
Summary
Choosing between different automated insulin delivery systems can be challenging for people with diabetes as it directly impacts their daily life and health. These systems are equipped with varying levels of insulin delivery automation and unique features designed to make diabetes management easier.Â
Some individuals may lean towards a system that demands minimal user input, while others may prefer more control over their insulin delivery with some automation assistance. In the end, the best choice will be the option that effectively manages glucose levels and integrates seamlessly into your lifestyle.