What Are Automated Insulin Delivery Systems?

AID systems – also known as hybrid closed-loop insulin pump systems – combine a continuous glucose monitor (CGM), an insulin pump, and an algorithm to automatically adjust insulin delivery based on real-time glucose levels.

There are five main automated insulin delivery systems on the market in the United States:

• Tandem Control-IQ+
• Medtronic MiniMed 780G
• Insulet Omnipod 5
• Beta Bionics iLet
• Sequel twiist

We’re going to take a detailed look at each system, including notable features, continuous glucose monitor integrations, and overall pros and cons.

Tandem Control-IQ+

Tandem Control-IQ+ is one of the most widely used AID systems. It has an advanced algorithm that automatically adjusts basal insulin delivery and gives correction boluses. 

It works with Tandem’s two tubed insulin pumps – t:slim X2 and Mobi. The t:slim X2 has a touch screen on the pump and holds 300 units of insulin. Mobi is smaller and can be worn on the body (though it still has a tube). It holds 200 units of insulin and is controlled solely with a smartphone app – there’s no user interface on the pump itself.

Control IQ+ is approved for ages 2+ and was also just recently approved for people with type 2 diabetes on insulin.

Notable Features

• Temp Basal Rate: Option to personalize insulin delivery for changing needs during automation
• AutoBolus: If glucose is predicted to be above 180 mg/dL, an automatic correction bolus will be delivered
• Extended Bolus: Option to extend a bolus for up to eight hours
• Sleep Activity: Uses a narrower and lower range of treatment values to help guard against lows and highs while sleeping
• Exercise Activity: Uses a narrower and higher range of treatment values to help guard against lows during activity

CGM Integrations  

Control-IQ+ is compatible with:

• All versions of Dexcom G6 for both t:slim and Mobi
• Specific versions of Dexcom G7 for both t:slim X2 and Mobi
• FreeStyle Libre 2 Plus with t:slim X2

Pros

• The only automated insulin delivery system with an extended bolus for up to eight hours during automated insulin delivery
• Two different choices for preferred form factor – t:slim X2 or Mobi
• It’s tried and true – Tandem’s first t:slim pump was FDA approved in 2011

Cons

• Requires tubing (as all of these systems do, except for the Omnipod), which may not be a con for everyone
• Infusion sets must be replaced and rotated every 2-3 days (typical for most tubing)

Medtronic MiniMed 780G System

Medtronic’s MiniMed 780G has an aggressive algorithm that includes something called Meal Detection technology. This is an advanced feature that uses current and past glucose trends to detect a missed meal dose. It’s a lot more forgiving than other systems if you forget to bolus.

The MiniMed 780G can predict glucose values several hours into the future which allows for adjustments to the insulin being infused. 

The 780G will be getting an upgraded continuous glucose monitor sensor with a better form factor called Simplera. Medtronic also has a new collaboration with Abbott to integrate one of their sensors, so soon we’ll have the option of pairing an Abbott sensor with a Medtronic pump.

Notable Features

• Basal and bolus adjustments every 5 minutes
• Meal Detection technology uses current and past sugar trends to detect a missed meal dose
• SmartGuard technology automatically adjusts basal insulin delivery based on your sensor glucose values to protect against highs and lows. It can be used in manual or auto mode, and it can also automatically stop and resume insulin delivery based on your values and low limit
• Target Setting: The 780G allows you to set a target as low as 100 mg/dL — one of the lowest on the market

CGM Integrations

• Medtronic’s Guardian 4 Sensor 
• Coming soon: Medtronic’s Simplera sensor and Abbott sensor

Pros

• One of the most aggressive automated insulin delivery system algorithms on the market
• Lowest glucose target setting available (100 mg/dL)
• Extended infusion set can be worn for up to 7 days

Cons

• Tubing can be inconvenient for some people
• The current Guardian 4 sensor has a difficult form factor (due to its size, the need for charging, and it only lasts 7 days)

Insulet Omnipod 5

The Omnipod 5 is the only tubeless patch pump on the market. It can be worn almost anywhere on the body, and it has a simpler setup compared to tubed pumps.

Omnipod 5 has an adaptive basal feature called SmartAdjust technology, which is calculated from the total daily insulin use and updated every three days at each Pod change.

Omnipod 5 is controlled with a smartphone app (or separate controller) and is cleared for people with type 1 diabetes ages 2+ and those with type 2 diabetes 18 and older.

Notable Features

• SmartAdjust technology: Predicts future glucose levels up to 60 minutes ahead using your continuous glucose monitor sensor value and trend
• Bolus doses can be given for meals using the Omnipod 5 app on your smartphone or with the controller
• Customizable target range: You can set glucose targets between 110–150 mg/dL
• The Pod has a waterproof IP28 rating for up to 25 feet for 60 minutes 

CGM Integrations

• Dexcom G6 and G7
• FreeStyle Libre 2 Plus

Pros

• No tubing – discrete and easy to wear almost anywhere on the body
• Learns and adapts over time to your personal glucose patterns and insulin requirements
• Disposable pump (no need to charge it)

Cons 

• Pods stop working after 80 hours and must be replaced
• The Pod holds 200 units of insulin and requires a minimum of 85 units to operate

Beta Bionics iLet Bionic Pancreas

The iLet Bionic Pancreas is unique because there are no settings, which means it’s a very hands off automated insulin delivery device. When you start on the system, the only thing you enter is your weight. There’s no correction factor, insulin-to-carb ratio, or basal rate. You just make simple meal announcements when you eat. The algorithm takes a week or two to learn about you, and then you’re set!

Notable Features

• Requires only weight as an initial input and adapts its dosing decisions over time
• No carb counting needed – you just announce meals as “breakfast”, “lunch”, or “dinner” and enter a size as “usual”, “more”, or “less”
• Glucose target can be set between 110 and 130 mg/dL and can be adjusted throughout the day as needed

CGM Integrations

• Dexcom G6 and G7
• FreeStyle Libre 3 Plus

Pros

• Simple setup – requires only your weight
• No carb counting
• Reduced decision fatigue

Cons

• No insulin adjustments for exercise
• If you’re high, you have to be patient and let the algorithm bring you back down to the desirable range (no correction doses)

Sequel Twiist

The twiist received FDA approval in March of 2024, so it’s the newest automated insulin delivery system on the block. It uses a sophisticated algorithm based on Tidepool Loop, so it’s very similar to the devices that use open source “Looping”. It directly measures the volume of insulin delivered with every dose, allowing for precise, tailored insulin management. The twiist is a tubed pump that’s small and light, yet holds 300 units of insulin. It’s expected to launch in the U.S. very soon.

Notable Features 

• Updates predictions every 5 minutes to create a 6-hour glucose forecast
• Glucose targets available from 87-180 mg/dL 
• Insulin dosage adjustments can be made by selecting emojis
• Half of the pump holds the insulin cartridge, which can be twisted off for disposal

CGM Integration

• Compatible with Abbott’s FreeStyle Libre 3 Plus sensor

Pros

• Sophisticated algorithm
• Small, lightweight, and water resistant up to 12 feet for one hour
• Holds 300 units of insulin and has enhanced blockage detection 

Cons

• Not available yet 

How to Choose the Right Automated Insulin Delivery System for You

Here are some questions to consider as you compare various systems:

• Do you prefer a tubed or tubeless pump?
• Is the pump compatible with your current continuous glucose monitor?
• How does the automated system adjust insulin delivery?
• Can you customize settings?
• Is the pump’s interface easy to navigate?
• What infusion set options are available?
• How long is the warranty period?
• Which system is covered by your insurance?
• How easy is the system to set up every 3-7 days?

Takeaways

All of these automated insulin delivery systems do a fantastic job improving time in range, reducing hypoglycemia risk, providing better overnight control, reducing long-term complications, and offering flexibility and peace of mind. 

Pump manufacturers are working toward systems that won’t require any patient input (i.e. carbs or meal announcements), aiming to create fully closed-loop systems (as opposed to hybrid closed-loop insulin pump systems). This technology could become a reality in the next few years.

Some pump manufacturers are also developing dual-hormone AID systems that deliver both insulin and glucagon. 

In the meantime, device companies are continuously working on more integrations, so soon we’ll be able to pick from an even wider variety of pumps and sensors that can all work together.

Choosing an automated insulin device may seem overwhelming, but the bottom line is that anyone can have success and benefit from any of the AID systems.

Please visit our video vault for more resources on diabetes management and automated insulin delivery systems.