Automated Insulin Delivery Systems for Treatment of Type 1 Diabetes: Strategies for Optimal Performance.

Background: The use of automated insulin delivery (AID) devices is now widespread in the management of type 1 diabetes (T1D), being used for younger and older children, adolescents, and adults. The integration of insulin pumps with continuous glucose monitors and smart management software in AID systems has significantly improved glycemic management compared to the separate application of each diabetes technology. The efficacy of AID systems has been demonstrated in randomized controlled trials (RCTs), but it is their application in real-world studies that fully demonstrates their impact for people with T1D.

Summary: Available AID systems differ in how they are initiated and how they calculate and deliver insulin, which dictates the parameters that can be adjusted for each system. Here, we discuss how each system can be best optimized for each individual user, taking into account their activities of daily life, including mealtimes and physical activity, with a focus on commercially available systems for pediatrics (Medtronic MiniMed 780 G, Tandem Control-IQ, Omnipod 5, CamDiab CamAPS, and Beta Bionics iLet. Another FDA-cleared AID is the Tidepool Loop, which, although not yet in real-world on-label use, is currently utilized in its open-source format). We also look at the essential process of initiating AID therapy with these devices and how to navigate the important first steps, once the decision to start using an AID system has been made.

Key messages: AID systems should be considered for all individuals with T1D who wish to use them, with a strong emphasis on ensuring equitable access to this technology. Achieving success with AID requires comprehensive guidance, education, and support with a focus on core diabetes management principles. These systems are relatively easy to initiate, from any prior therapy and at any time, including shortly after diagnosis, using personalized, and appropriately proactive settings. Effective meal management remains crucial for achieving optimal glycemic control, while regular follow-up and timely adjustments to AID settings are essential for maintaining their effectiveness over time.