Diabetes technologies are changing quickly, so we at CWD want to make sure you have the up-to-date information on what’s available to you in the U.S. For your reference and to help with any decisions you may need to make, we put together this chart of the current Automated Insulin Delivery (AID) systems for people with diabetes, as well as some helpful information about AID in general.
Some Quick Definitions:
Basal – Background insulin
Bolus – insulin taken for food or correcting a higher than target blood glucose
CGM – Continuous Glucose Monitor
Open Loop – when the pump is operating independently of the continuous glucose monitor
Automated Insulin Delivery or Hybrid Closed-Loop – when the pump and CGM work together to manage glucose levels to a certain extent
Data Sharing – the ability to share CGM and/or insulin pump data with someone else who can view the data remotely (see our article about sharing glucose data)
Calibration – the requirement of entering a fingerstick glucose level to confirm the sensor glucose – none of the current systems require calibration (WOO!)
When should you opt to switch to open loop?
There are some situations where stopping the use of closed-loop is recommended, such as:
- To use temporary basal rates
- For illness, excessive stress, presence of ketones, during use of steroids, or a time in which your insulin needs are different than usual.
- To use for 2-4 hours after syringe or pen injection because the system will not know you took the injection.
Why is it called “Hybrid Closed-Loop”?
For all these systems, the person wearing the devices must manually input the carbohydrates they consume to bolus for meals. There are more closed-loop systems currently undergoing study and development that will need less user interaction, and hopefully one day they won’t need any interaction!
How do I get one of these?
The easiest way would be to reach out to your healthcare provider or to the manufacturer itself. Endocrinology offices may have physical devices that you can look at in clinic so that you can get a better feel for them. Then comes the issue of figuring out what your insurance is willing to cover, which is what dictates many people’s decisions on which system to obtain. Most insurance companies will allow a person with diabetes to get a new insulin pump every four years, which means whatever you choose, you may have to keep for four years unless you want to pay out of pocket for a different system.
However, you can get an Omnipod system through pharmacy versus medical benefits. And you can always choose to go to manual mode, with injections for a temporary period if you need a break from wearing the devices. Nothing is forever, and technology continues to change rapidly, even in the diabetes space.
More Resources:
There are a couple of great additional resources that can help you decide what device to use –
- diabeteswise.org is a website designed by diabetes psychologist Dr. Korey Hood and his team at Stanford University to help people with diabetes choose what technologies fit best into their lives. They also have information about the cost of devices, guides on how to get devices, and personal stories from others living with diabetes.
- The Panther Program has a device comparison chart with even more details than the one we created above. They also have other great resources for when you have skin challenges related to diabetes devices as well. This is managed by Cari Berget of the Barbara Davis Center in Colorado.
Sometimes you will need to advocate for yourself to get the device of your choice and having a supportive health care provider can be extremely valuable for this. There are also times when the provider is the reason you have not been able to get the device, and in that case it’s probably time to find a new provider. (See our article on Implicit Bias and Prescribing Habits for more information.)
Bottom Line:
It’s great to have options because people are different, and everyone has their own needs and desires. Not everyone wants to wear a pump or CGM, and that’s okay. You have to do what’s best for you and your diabetes, because at the end of the day, you’re the driver of your own diabetes bus. Here’s to hoping you find something that makes the ride easier for you!
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES
