Automated Insulin Delivery: Great Strides in the Past, Great Needs for the Future

Advances in diabetes technologies are transforming the management of type 1 diabetes. In this review, we reflect on the successful translation from bench to bedside of hybrid automated insulin delivery (AID) systems, including development of the core components as well as commercialization, and then we focus on progress toward next-generation fully automated systems. With the availability of greater choice, we review the factors that influence users and health care professionals when selecting an AID system while recognizing the challenges of comparing AID systems. We discuss the importance of the diabetes technology ecosystem in ensuring equity of access and effective implementation. We contrast the different potential approaches to fully automated systems that could reduce burden, including the use of ultrarapid insulins, adjunctive therapies, integration of signals from additional wearables, and dual-hormone systems. Finally, we review emerging evidence for the use of AID in more vulnerable people with type 1 diabetes, in adults with type 2 diabetes, in people with cystic fibrosis–related diabetes, and in the inpatient setting.