2025 Update on Automated Insulin Devices (AID)

2025 Update on Automated Insulin Devices
Rosalie Tierney, RDN, LD, CDCES

People living with type 1 diabetes have more options to manage their blood sugar now than ever before. Long gone are the days of checking blood sugar with a glucometer in the middle of the night, or eating large amounts of carbohydrates to keep from dropping low. Automated insulin delivery (AID) systems improve blood sugar control while reducing burden for people living with diabetes. There are two components in an AID closed-loop system, the insulin pump and continuous glucose monitor (CGM). These devices are in constant communication so insulin delivery can adapt to changes in blood sugar, mimicking the pancreas. Diabetes technology is always evolving, but here is the latest on AID systems - for now.

Medtronic 
If you or a loved one have been living with diabetes for a while, you are likely well acquainted with Medtronic.The most up to date version is Medtronic 780G, and can be a great choice for those desiring more of a hands-off approach. (Engagement in your care is still important!)  
CGM Integration: Medtronic Guardian Sensor 4. Medtronic is working on an all-in-one, disposable sensor called Simpleta Sync. We can also expect integration with Freestyle Libre CGM, stay tuned! 
Algorithm: SmartGuard technology is a reactive algorithm that offers basal adjustments and correction boluses every 5 minutes. If a mealtime bolus is forgotten, the pump will detect the rapid rise in blood sugar and automatically deliver correction doses to help lessen the glucose spike. It will also suspend insulin delivery when a low blood sugar is detected. 
User Interface: Traditional engagement with the insulin pump 
Target Glucose Range: 100-120 mg/dL 

Omnipod
Omnipod 5 is unique in the fact that it is a tubeless system, meaning the pump, also referred to as a pod, delivers insulin directly to the body-  no infusion set or tubing required. This is a great option for those who are active in work or personal life, or with young kids that like to pull on anything and everything. Omnipod 5 is the first and only AID system approved for Type 2 diabetes!  
CGM Integration: Dexcom G6, Dexcom G7, Libre 2+
Algorithm: Often described as a predictive pump, SmartAdjust technology uses real time glucose and predicted glucose levels 60 minutes into the future to adjust the insulin basal rate every 5 minutes. If predicted glucose is indicative of hypoglycemia, the system will automatically pause or decrease insulin delivery, lessening the frequency and severity of low blood sugar. 
User Interface: Managed via smartphone app or Omnipod 5 controller. 
Target Glucose Range: 110-150 mg/dL 

Tandem 
Tandem has two insulin pump options on the market, t:slimX2 and Tandem Mobi.The t:slimX2 is a traditional pump with a touch screen, while the Mobi is designed to be more portable. The Mobi is so small it can fit in the coin pocket of your jeans! Tandem Mobi can hold 200 units of insulin while the t:slimX2 can hold 300 units of insulin. Both contain the most advanced Control-IQ technology. 
CGM Integration: Dexcom G6, Dexcom G7, Libre 2+
Algorithm: Control-IQ technology uses both approaches (predictive and reactive) to automatically adjust basal and bolus insulin delivery every 5 minutes. It predicts glucose levels 30 minutes into the future to adjust the basal rate, and can deliver automated correction boluses every 60 minutes as needed. Basal delivery will decrease if glucose is below target, and pause if glucose is predicted to be below 70 mg/dL within 30 minutes. 
User Interface: The Mobi is managed with a compatible smartphone via the t:connect mobile app. The t:slimX2 requires engagement with the pump, however users have the ability to use the t:connect mobile app for most commands. 
Target Glucose Range: 112.5-160 mg/dL

Beta Bionics 
The newest insulin pump on the market, Beta Bionics iLet pump, is reinventing everything we know about AID systems.Tired of carb counting? This is your solution. While carb counting is not required, users do have to be carb aware. This pump requires the user to announce meals, but does not require input of carb amounts or blood sugar. 
CGM Integration: Dexcom G6, Dexcom G7, Libre 3+ 
Algorithm: The iLet algorithm only needs the user’s body weight to initiate insulin delivery. That’s right- no correction factors, insulin to carb ratios, or preset basal rates. This system is constantly learning from glucose trends to adapt basal delivery and bolus corrections accordingly. It learns the most within the first week, so it is imperative that users follow protocol since settings cannot be adjusted. If blood sugar is below 60 mg/dL, insulin delivery is paused for one hour. 
User Interface: Management through insulin pump touchscreen 
Target Glucose Range: “Lower” (110 mg/dL), “Usual” (120 mg/dL), “Higher” (130 mg/dL) 

Biotechnology developers and engineers continue to close in on the “perfect” artificial pancreas. Efforts are being made for a dual-hormone AID system, a device containing glucagon and insulin so the system can treat high and low blood sugars. Others are working on an all-in-one system, so one device can simultaneously sense glucose and deliver insulin.

In the near future, we can expect a new AID system to hit the market, called Twiist. Twiist will be utilizing the recently FDA-approved algorithm called Tidepool Loop, designed and developed by people living with diabetes. Some unique features of this system include retroactive adjustable carb entries (for when your eyes are bigger than your stomach), a low and large glucose target range (87-180 mg/dL), and ability to bolus through your Apple Watch (talk about discrete).  

If you would like support finding what AID therapy would work best for you, how to optimize your current system, or general diabetes and nutritional support, get in touch! 
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