Practical Considerations and Implementation of Automated Insulin Delivery Systems

The technological progress to date with automated insulin delivery (AID) has ushered in a new era of challenges and opportunities for people with diabetes (PWD), spotlighting implementation considerations. Beyond physiologic and technologic variation, cost, access, and health care professional (HCP) endorsement/experience lead to uneven uptake of AID technologies and attenuate universal ease of use. For AID to be broadly implemented, we must prioritize the lived experience for PWD and consider how to alleviate burden to promote physical/functional health, psychological well-being, and social well-being. Expectations and education help HCPs and PWD navigate the similarities and differences between AID devices, and help find common ties: users need to give the system time to work, learn to trust it, and not try to “trick” the system. Despite these learnings, disparities in uptake exist, both in clinical trials and in routine clinical care. Strategies to proactively address AID disparities must be enacted at multiple levels, including recognizing HCP biases, using clinic-based benchmarking efforts, and addressing insurance and policy barriers, all of which increase in importance as AID becomes more common for people with type 2 diabetes. Furthermore, broader implementation will require comprehensive health care system integration efforts, including new data solutions. Overall, the success of AID requires ongoing transformation of clinical paradigms, with lockstep alignment between PWD and their families, health care professionals, researchers, funders, policy makers, and industry partners.