Blog - Diabetes Treatment
Automated insulin delivery systems, explained
What is an artificial pancreas?
If you’re tapped into the diabetes world, you may have heard the term “artificial pancreas.” This describes the future of “automated insulin delivery systems” (AID system). The idea is for it to administer insulin fully automatically, thereby replacing the missing pancreas function for people with diabetes. While not quite this advanced yet, several developments bring us ever closer to a fully automated solution. They’re many insulin pumps and applications available right now that integrate with Dexcom continuous glucose monitoring (CGM) systems to offer state-of-the-art management for insulin delivery. So, what is an AID system?
In general, an AID system is made up of three parts that work together that tries to mimic as close to the biological situation as possible how a pancreas regulates insulin, an important hormone needed to use glucose, in the body. It is mainly used to help people with type 1 diabetes (T1D).1
What does an AID-system do?
In T1D, the pancreas does not produce insulin or makes very little. Insulin acts like a key that lets blood glucose; what people sometimes call blood sugar; into your body’s cells to use as energy. Without insulin, glucose can’t get into cells and builds up in the bloodstream, causing high blood glucose levels. High blood glucose levels are damaging to the body and if left untreated, poses a significant risk to health. 2
People with T1D manage their blood glucose levels by checking it and taking insulin several times a day. An AID system automatically monitors glucose levels, calculates the amount of insulin needed throughout the day and night, and delivers it.1 Current systems available automate background insulin requirements and some offer additional support for meals. However, you’ll still need to administer insulin using the system before food or must record the meal in the system in time.
Hybrid Closed Loop (HCL) systemen
Een 'hybrid closed loop'-systeem (HCL-systeem) is een type AID-systeem. Een 'fully closed loop'-systeem zou geen interacties met de gebruiker meer nodig hebben en zou de insulinehoeveelheid volledig automatisch reguleren. 'Hybrid' geeft aan dat het systeem de insulinetoediening ‘semi-automatisch’ uitvoert en dat gebruikers nog steeds af en toe handmatig bolussen moeten toedienen. Voorbeelden zijn vóór maaltijden en mogelijk vóór, tijdens en na het sporten (evenals in een paar andere gevallen) om rekening te houden met sterke stijgingen van de bloedsuiker en om schommelingen tot een minimum te beperken.
A brief history of insulin delivery
The year 2021 marked 100 years since the discovery of insulin. In recent years, technology has changed diabetes management.
First it was a syringe to inject insulin, then later came insulin pens and insulin pumps. The growth of diabetes technologies increased with the invention of AID systems, and even more when AID systems began to work with consumer electronics and cloud-based data. Below is a quick timeline of some key milestones in the history of insulin delivery.3
- 1921: Insulin first isolated and administered to animals
- 1922: Insulin first administered to someone with T1DM
- 1923: Commercial production of insulin
- 1924: First specialized insulin syringe
- 1954: First disposable glass syringe
- 1963: Invention of first insulin pump
- 1979: Introduction of the first commercial insulin pump
- 1985: Introduction of the first insulin pen
- 2006: Emergence of sensor augmented pump therapy
- 2015: First hybrid closed-loop (HCL) system
- 2023: NICE introduces a TA for HCL systems in T1D
3 components of an automated insulin delivery system
An automated insulin delivery system is made up of three parts: a continuous glucose monitoring (CGM) system, a computer-controlled algorithm (that either runs on an app on a compatible smartphone, a controller or the pump itself, depending on the system), and an insulin pump. Read on to learn more about each part of an AID system.
1. Continuous glucose monitoring system
The first part is a CGM system, which tracks glucose levels every few minutes using a sensor that is inserted under the skin. There are different kinds of CGM systems available, Dexcom is specialised in patch CGM systems that are stuck on the skin with the tiny sensor just a few millimetres below the skin. The sensor sends the information to a smartphone and/or an insulin pump automatically in real-time.
While a blood glucose meter (BGM) measures blood glucose levels at a specific moment in time (when someone pricks their finger), CGM systems provide readings of the interstitial glucose every few minutes. A BGM is like a picture – providing a single glucose “snapshot” – while a CGM system is like a video, providing a constant stream of information on glucose levels, trends, and overnight data.4
People who use a CGM system can view readings on their phones (or dedicated receivers) and use an app to keep track of trends and insulin doses to discuss with their doctor. They can also get notifications when their glucose levels are too high or too low, so they know when to take action.
2. Insulin pump
The insulin pump can administer required amounts of insulin regularly through a small tube called a cannula. This cannula delivers insulin underneath the skin, removing the need for multiple daily injections. Many insulin pumps also include a calculator which enables the user to deliver accurate doses of insulin required before eating.
Insulin pumps exist in two major form factors; a tubed pump and a patch pump. The tubed pump is small device, incorporating some kind of insulin reservoir, which connects to the cannula via a tube. The patch pump is a similarly small device filled directly with insulin, but it sits directly on the skin at the cannula site.
3. Algorithm
An algorithm connects the CGM system and insulin pump to allow communication between them.5 In some systems, the algorithm sits in the pump, in others it is housed by a Bluetooth connected mobile device, such as a smartphone. Whilst all algorithms use different methods to modify insulin delivery, they all analyse recent CGM data and tell the pump how much insulin to deliver to keep glucose levels in the target ranges. It does this day and night, even during sleep.6
Pros and cons of hybrid close loop (HCL) systems as Automated Insulin Delivery
Diabetes technology isn’t a good fit for everyone. Here, we’ll take you through the pros and cons of using an AID system, so you have the information you need to make your own decision.3,7
The pros of a hybrid closed loop system
- Glucose levels will more often be in your target range, and you’ll likely have fewer highs and lows
- You won’t have to manually inject insulin as often when not using the system or in case of problems
- You can adjust your insulin more easily before, during and after exercise
- You’ll have more lifestyle and eating flexibility
- It ensures that you have continuous delivery of insulin
The cons of a hybrid closed loop system
- Your pump needs to be attached to you for the system to work
- The tubing can sometimes get blocked
- You'll need to take the time to learn about your system, different systems vary slightly in their features and useability
- In some instances, you’ll still need to inject insulin
- The adhesive can irritate some people’s skin
- Depending on insurance coverage, it could be more expensive
How insulin pumps integrate with Dexcom CGM Systems
Dexcom CGM Systems can be used alone or with other devices as part of an AID system.* They can communicate wirelessly with insulin pumps and send glucose readings every 5 minutes. The pumps use the CGM readings to determine an insulin dose.
In addition to insulin pumps, Dexcom CGM Systems can connect with diabetes management tools and apps, supporting more customisable and convenient treatment options. Through partnering with digital health platforms, Dexcom empowers users and healthcare professionals to view glucose data in the system of their choice.
NICE guidance on HCL systems
As of May 2023, the National Institute for Health and Care Excellence (NICE) is in the process of updating a technical appraisal that’s been running since 2020 and is expected to be implemented by the end of 2023. It now recommends hybrid closed loop systems as an effective option for managing blood glucose levels in type 1 diabetes.8 This means that, should you fulfil the requirements of the appraisal and your doctor agrees, you will qualify for NHS funding for HCL. As such, you could be reimbursed for HCL systems that connect with the Dexcom G6, such as Tandem t:slim X2 with ControlIQ, CamAPS FX, mylife YpsoPump or Omnipod® 5 with SmartAdjust.
Learn more about our partners below:
Tandem and Dexcom G6
The Tandem t:slim X2 is an insulin pump that integrates with the Dexcom G6 CGM System as part of an AID system. Tandem Control-IQ technology uses Dexcom G6 readings to predict glucose levels 30 minutes ahead and automatically adjust insulin.
YpsoPump and Dexcom G6
The mylife YpsoPump in conjunction with the mylife App integrates real-time glucose readings from the Dexcom G6. Boluses calculated using Dexcom G6 readings can be delivered direct from the user’s smartphone. Thanks to the pumps icon-based menu and the modern touch screen, it’s extremely easy to operate. The compact and lightweight design makes it a discreet companion in everyday situations.
CamDiab and Dexcom G6
CamAPS FX is an algorithm that sits on an app on your smartphone, that automatically adjusts insulin delivery on your insulin pump based on readings from your Dexcom CGM System. It learns and adjusts according to your insulin needs, while giving you the freedom to change settings.
Glooko and Dexcom G6
Glooko is a diabetes management platform that helps you understand how food, activity, and medication affect your glucose levels. It syncs data from your insulin pump and Dexcom CGM System, allowing you to easily track your medication, food and lifestyle data. You can also share your reports with your healthcare provider, so they can make informed changes to your care plan and support you in between office visits.
OmnipodⓇ 5 en Dexcom G6
Het Omnipod® 5-systeem combineert slangloze insulinepompinnovatie met de kracht van CGM-technologie. Het Omnipod® 5-systeem bestaat uit de draagbare, waterdichte* Omnipod® 5 Pod, die een algoritme, het Dexcom G6 CGM-systeem en de Omnipod® 5 Controller bevat. De Omnipod® 5 pod gebruikt gegevens van Dexcom G6 om dag en nacht automatisch insulineaanpassingen uit te voeren.
Dexcom CGM is made for connections.
*To learn more about insulin pump integrations and compatibility with Dexcom G6, visit dexcom.com/g6/integrations-and-compatibility.
1 Ntl Institute of Diabetes and Digestive and Kidney Diseases. Artificial pancreas. NIH.gov. https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/artificial-pancreas. Accessed 18/8/22.
2 Centers for Disease Control and Prevention. What is Type 1 Diabetes? CDC.gov. https://www.cdc.gov/diabetes/basics/what-is-type-1-diabetes.html. Accessed 22/8/22.
3 Kesavadev J, et al. Diabetes Ther. Evolution of Insulin Delivery Devices: From Syringes, Pens, and Pumps to DIY Artificial Pancreas. 2020 Jun;11(6):1251-1269.
4 diaTribe. Continuous Glucose Monitors. DiaTribe.org. https://diatribe.org/continuous-glucose-monitors-cgm. Accessed 22/8/22.
5 U.S. Food and Drug Administration. What is the pancreas? What is an artificial pancreas device system? FDA.gov. https://www.fda.gov/medical-devices/artificial-pancreas-device-system/what-pancreas-what-artificial-pancreas-device-system. Accessed 22/8/22.
6 Juvenile Diabetes Research Foundation. What is an artificial pancreas? JDRF.org.uk. https://jdrf.org.uk/our-research/about-our-research/treat/artificial-pancreas/. Accessed 22/8/22.
7 Diabetes UK. Insulin pumps. Diabetes.org.uk. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/insulin-pumps. Accessed 23/8/22.
8 NICE. Hybrid closed loop systems for managing blood glucose levels in type 1 diabetes. https://www.nice.org.uk/guidance/indevelopment/gid-ta10845. Accessed 17/7/23
1 Ntl Institute of Diabetes and Digestive and Kidney Diseases. Artificial pancreas. NIH.gov. https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/artificial-pancreas. Accessed 18/8/22.
2 Centers for Disease Control and Prevention. What is Type 1 Diabetes? CDC.gov. https://www.cdc.gov/diabetes/basics/what-is-type-1-diabetes.html. Accessed 22/8/22.
3 Kesavadev J, et al. Diabetes Ther. Evolution of Insulin Delivery Devices: From Syringes, Pens, and Pumps to DIY Artificial Pancreas. 2020 Jun;11(6):1251-1269.
4 diaTribe. Continuous Glucose Monitors. DiaTribe.org. https://diatribe.org/continuous-glucose-monitors-cgm. Accessed 22/8/22.
5 U.S. Food and Drug Administration. What is the pancreas? What is an artificial pancreas device system? FDA.gov. https://www.fda.gov/medical-devices/artificial-pancreas-device-system/what-pancreas-what-artificial-pancreas-device-system. Accessed 22/8/22.
6 Juvenile Diabetes Research Foundation. What is an artificial pancreas? JDRF.org.uk. https://jdrf.org.uk/our-research/about-our-research/treat/artificial-pancreas/. Accessed 22/8/22.
7 Diabetes UK. Insulin pumps. Diabetes.org.uk. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/insulin-pumps. Accessed 23/8/22.
8 NICE. Hybrid closed loop systems for managing blood glucose levels in type 1 diabetes. https://www.nice.org.uk/guidance/indevelopment/gid-ta10845. Accessed 17/7/23