Pumps Plus: Automated Insulin Delivery Systems Coming Soon

How can we reduce the burden of type 1 diabetes? Automated insulin delivery systems could be the answer. Data from randomized controlled trials show that patients who use automated insulin delivery systems have greater time in target range, fewer glucose swings throughout the day and especially at night, and overall HbA_1C improvements.

Changes to the type 1 diabetes standard of care are on the horizon. The first FDA-approved automated insulin delivery system, the Medtronic 670G Hybrid Closed Loop (HCL) system, will enter the market this year. Additional innovative systems are expected to follow.

A review article published in Pediatric Diabetes discusses these devices' challenges and clinical implications, as well as the learning curves experienced by patients and providers.

Existing insulin pump devices are functionally similar, but newer automated delivery systems include pumps augmented with continuous glucose monitors and dosing algorithms. Each system is unique in subtle ways. Automated systems function in 2 ways: closed loop/auto mode (adjusting insulin delivery every 5 minutes) or standard open loop/pump mode (suspending insulin delivery for safety).

The authors used the acronym CARE (calculate, adjust, revert, and educate) to simplify the understanding of automated insulin delivery.

• CALCULATE: Automated systems have fixed and modifiable parameters for dosing that may differ for auto and pump mode. Clinicians need to understand the parameters to dose patients properly.
• ADJUST: Users need to know how to adjust insulin to manage glycemic excursions.

• REVERT: Patients must know when the device reverts to pump mode automatically and how to manage this. Patients should also know when to manually revert to pump mode such as during illness.
• EDUCATE: Device manuals and manufacturer websites are important information sources for patients and providers.

The potential for improved diabetes management exists with automated insulin delivery systems, but health care providers and patients will need education and help to use systems effectively. Initially, experts anticipate that these systems will become the standard of care in type 1 diabetes but eventually, they may help patients with uncontrolled type 2 diabetes, too.

Reference

Messer LH, Forlenza GP, Wadwa RP, et al. The dawn of automated insulin delivery: a new clinical framework to conceptualize insulin administration. Pediatric Diabetes. 2017;0:1—4. doi: 10.1111/pedi.12535.