Introduction
The management of diabetes in those who require intensive insulin therapy has long been a technological challenge. The number of devices that can be incorporated into clinical care has significantly increased over the past ten years. We have now entered an era where insulin delivery through insulin pumps can be adjusted based on sensor glucose data. This development is mainly due to the availability of trustworthy systems for continuous glucose monitoring. Following regulatory approval, the first automated insulin delivery (AID) systems have been accepted into clinical care over the past few years. A community of people with type 1 diabetes has also developed its own systems using a do-it-yourself strategy and products designed for independent use.
What Are Automated Insulin Delivery Systems?
The goal of automated insulin delivery is to use continuous glucose monitors (CGM) and clever algorithms to adjust insulin delivery via pump automatically. This technology is known by many names, including artificial pancreas, hybrid closed loop, and bionic pancreas. These products are designed to lessen or completely eliminate hypoglycemia, increase time in range, and lessen hyperglycemia, particularly overnight. AIDs are made to perform the functions of the pancreas. People with type 1 diabetes (T1D), an autoimmune disease in which the body kills its insulin-producing cells, are the main users of these products. There are three components to an AID system:
-
A Continuous Glucose Monitor (CGM): Through a tiny sensor that is applied to the skin and has a separate cannula from the pump, CGM continuously measures blood sugar levels. Currently, there are two CGMs on the market in the US, that continuously provide high and low alerts as part of the device functionality.
-
An Insulin Pump: By placing a small cannula or infusion site under the skin, an insulin pump can continuously deliver insulin to the body.
-
An Algorithm: It connects the CGM and the pump and automates how they react to one another, serving as the system's brain.
AID system currently consists of a continuous glucose monitor and an insulin pump (CGM). To make the whole thing work, a receiver (a different handheld device or, eventually, a smartphone mobile application) controls the monitor using complex software algorithms.
The goal is to fully automate blood glucose (BG) control so that the wearer is relieved of the need to manually calculate insulin dosages or reductions based on fingerstick blood sugar readings. Some systems even can automatically stop insulin delivery in response to low blood sugar readings discovered by the CGM. Additionally, some pumps are experimenting with including glucagon in addition to insulin to raise blood sugar levels when necessary.
These systems are in various stages of development, ranging from early commercial products to clinical trials to systems that have been hacked by tech-savvy DIYers who don't want to wait for FDA-approved products. Nevertheless, amazing progress is being made, and it appears that new organizations and businesses are starting to work on this innovative development in diabetes technology.
Why Is Technology Important for Diabetes?
For a diabetic person, it can be challenging to handle routine diabetes tasks like controlling blood glucose levels, taking insulin, organizing meals, and maintaining an active lifestyle. Their mental health may suffer as a result of all that work.
In their lifetimes, 1 in 4 diabetics will experience depressive symptoms. Teenagers with type 1 diabetes experience depression five times as frequently as their peers. AID systems make management easier and lessen the burden of having diabetes. Benefits of an AID system include:
-
Removing some daily tasks to reduce the burden of disease.
-
Making changes or recommendations based on glucose CGM real-time data.
-
Enabling self-modifying insulin delivery, which can shorten the time in range.
-
Lowering or stopping insulin intake to prevent hypoglycemia (low blood glucose).
-
Increasing insulin dosage or bolusing it to treat or prevent hyperglycemia (high blood glucose).
-
Hands-off features to improve A1C.
How Do Insulin Pumps Function?
Normal insulin pumps are smart, semi-automated devices. They support individuals with diabetes in maintaining normal blood glucose levels. A tiny catheter that is inserted into the skin and changed every three days is used to administer insulin. Standard insulin pumps deliver medication at set intervals. This indicates that it does not automatically exchange information with a CGM to adjust insulin levels. They are interactive systems.
An insulin pump has two ways to deliver quick-acting or short-acting insulin:
-
Basal: A minimal background insulin dose that is continuously administered.
-
Bolus: Insulin administered with meals or to lower an elevated or rising blood sugar level.
What Are the Newer Developments, and How Do They Work?
The technology of pumps is advanced further by AID systems. They use some hands-free technology and modify insulin in response to variations in a person's blood glucose levels. There are two of these DIY systems that have received FDA approval and other well-liked DIY systems that have not received FDA approval. There are three crucial steps in AID systems:
-
Identification: Changes in glucose levels are detected by CGM.
-
Communication: Information about blood glucose levels is exchanged with an algorithm (in the insulin pump).
-
Action: A bolus is suggested or automatically administered, and/or basal insulin delivery is modified.
It would not be possible to completely simplify living with diabetes using any AID system, no matter which one you choose. The responsibility to fill, wear, charge, insert, and maintain the daily equipment will remain.
There are a few things to keep in mind regarding support, including:
-
The device manufacturer will provide round-the-clock support for troubleshooting with FDA-approved systems. An insulin pump trainer will also assist in getting started and modifying personal settings.
-
There is no customer support for troubleshooting with DIY systems. Instead, there are instructions that can be followed along with online forums for community support.
Are AID Systems Safe?
According to research, these systems are generally reliable and secure. These systems are not perfect, just like any medtech device. Users must exercise caution because blood sugar readings outside the normal range can still occur. This is particularly true for systems not subject to FDA regulation because the algorithms are frequently still being developed.
Conclusion
AID systems can lessen the mental strain and burden on users and caregivers caused by having to monitor their glucose levels constantly. Despite the excitement and promise this new technology generation has brought, it cannot cure diabetes, but can help in managing the condition.
