The terms abound.
“Closed-loop,” “hybrid closed-loop,” “automated insulin delivery,” and even “artificial pancreas.”
While the language makes it sound like the system runs itself, it’s actually far more nuanced. In reality, today’s insulin systems and devices are powerful – but still require active participation from the person wearing them.
And, unfortunately, that continues to be an issue in Black communities, where the adoption of these systems is far lower, across youth and adults, even after accounting for insurance and socioeconomic factors.
Without a doubt, change is needed, which is also why an accurate understanding of these terms, systems, and their applications is so vital. Literally vital, because if you can understand what the technology actually does — and what it does not do — then you can have measurable impacts on your diabetes management.
Let’s dive into everything you need to know about automated insulin delivery (AID).
Basically, a closed-loop, or automated insulin delivery (AID), system links three parts: a continuous glucose monitor (CGM), an insulin pump, and a computer algorithm.
Quite the tech!
But let’s break it down further. In terms of specific functions, the CGM measures glucose, the algorithm decides how much insulin you require, and the pump delivers it as needed.
A fully closed-loop system would have the algorithm handle everything, including meals, but that version is still largely in development. What is currently available now is hybrid closed-loop technology. That means that these systems automatically adjust background (basal) insulin up or down based on your CGM readings.
Some versions may even deliver automatic ‘correction doses’ when your glucose is high. However, a word of caution. You must still tell the system about meals by entering carbohydrate information and delivering a meal bolus, a rapid-acting dose of insulin taken to cover those carbohydrates.
When we call this system “hybrid,” what we mean is that the loop is closed for basal insulin between meals and overnight, while you still provide input for meals. Some newer systems can also deliver automated correction doses, but you generally still need to announce meals and, depending on the system, enter carbohydrate information or otherwise guide your mealtime insulin dose.
This can be confusing because people often use the term “artificial pancreas” to describe these systems. The name makes sense—the technology is designed to mimic some of the insulin-delivery functions of a healthy pancreas—but current systems don’t completely replace the pancreas or take over all of the decision-making involved in managing blood glucose.
Even with an automated insulin delivery system, you still have to handle some things yourself. In the future, the algorithm may manage many of these issues, but for now, a little human input is still needed.
Always remember to:
These limitations and potential shortcomings should be discussed with your doctor regularly. After all, different systems and models vary, so some may offer additional automations you should fully understand.
Here’s the good news. Compared to multiple daily injections or standard pumps, these required tasks are fewer, but they are not zero. Often, the biggest reduction in mental burden comes overnight and between meals. That is when the algorithm adjusts basal insulin without needing constant input.
Tired of waking up multiple times during the night to check your numbers and manage highs and lows? Depending on your automated insulin delivery system, the technology may be able to handle much of that background work while you sleep.
And the potential result? Better sleep and, hopefully, a little more peace of mind.
Ultimately, improved outcomes matter.
Real-world data shows how hybrid closed-loop systems work. They not only increase the time people spend in the target glucose range, but can also lower A1C compared with standard pump therapies or injection/CGM combinations.
Moreover, benefits have been demonstrated across age groups and, more recently, in some people with insulin-treated type 2 diabetes. These improvements are particularly meaningful for Black communities where diagnoses are significantly higher than in white counterparts.
However, to realize these benefits, users must be mindful. Users should use the system consistently and follow the intended implementation. If meal boluses are missed, sensors expire, or alerts are ignored, these can diminish benefits.
Unfortunately, many Black populations are using these technologies less frequently than their racial counterparts, despite the fact that the systems often confer AIC improvements for users, adults and youth.
Some of the barriers to appropriate use are as follows:
For these reasons, clinics must become more intentional in their efforts. They should educate both clinicians and patients to streamline the start-up process and close the gaps.
Of course, that doesn’t mean additional questions won’t arise.
For instance:
Will the devices be visible under work clothes?
How will data sharing work in a multi-generational household?
Is there reliable internet/smartphone access for updates and remote monitoring?
These are legitimate considerations that should be part of any discussion with your healthcare provider(s).
To bring it all full circle (or loop), it’s important to recognize that no closed-loop system currently available is fully automatic. These are not cures; rather, they’re sophisticated tools that can reduce some of the constant decision-making of insulin therapy.
They still require you to manage meals, maintain the technology, and do a little problem-solving. Before opting for AID, understand this partnership and don’t shy away from solid initial training.
Ongoing support from your doctor(s) can also help.
Before using one of these systems, consider the following pertinent questions:
“What will I need to do every day that the system can’t?”
“How much training is provided?”
“Is it available in a way that fits my schedule?”
“What happens if the system fails or I need to switch back?”
“How does coverage work – are there assistance programs?”
By recognizing real-world challenges and addressing them ahead of time, you can make using your AID system much smoother. Don’t let a heavier burden of diabetes complications due to race weigh you down.
At the end of the day, fair access to these systems is both a medical and an equity issue. You have every right to advocate for yourself! And if you’re hesitant, your healthcare team can empower you with the knowledge and tools you need.
These systems can work, but you have to work them too. Take that first step to learn more, and see whether AID systems are right for your diabetes management.
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