Research Gaps, Challenges, and Opportunities in Automated Insulin Delivery Systems.

Journal: Diabetes technology & therapeutics
Published Date: Jul 1, 2025

Abstract

Since the discovery of the life-saving hormone insulin in 1921 by Dr. Frederick Banting in 1921, there have been many critical discoveries and technical breakthroughs that have enabled people living with type 1 diabetes (T1D) to live longer, healthier lives. The development of insulin pumps, continuous glucose monitoring systems, and automated insulin delivery (AID) systems has enabled people living with T1D to safely manage their glucose, reduce their HbA1c, and improve their overall health and quality of life. Nevertheless, AID systems are not yet designed for all people with T1D, and they perform best during the overnight period when meals and exercise are not occurring. AID systems are not fully automated in that they require the person using the system to announce meals and exercise to the system to avoid dangerous hyper- or hypoglycemia, respectively. In this review, which is one of a collection of articles to commemorate the 75th anniversary of the National Institute for Diabetes and Digestive and Kidney Diseases, we celebrate the commercialization of the AID and discuss the major challenges and research gaps that remain to be solved to enable single- and multihormone AID systems to more fully support glucose management in people living with T1D. More research is required to design and evaluate more intelligent AID systems that do not require accurate carbohydrate estimations or announcements for meals and exercise. Current AID systems are also not designed to be used by older adults or pregnant people. Results are presented on new AID systems that can automatically respond to meals and exercise. Results are also presented on evaluations of AID systems in older adults and pregnant people. Next-generation AID systems will need to support all people, including older adults, people during pregnancy, athletes, and people who may be too busy to announce carbohydrates or exercise to the system. Solutions are now becoming available that will enable AID systems to support a broader range of people living with T1D by leveraging the latest technologies in artificial intelligence and adaptive control.

Authors

  • Peter G Jacobs
  • Carol J Levy
    Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
  • Sue A Brown
    Center for Diabetes Technology, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
  • Michael C Riddell
    York University, Toronto, Canada.
  • Ali Cinar
    1 Department of Chemical and Biological Engineering, Illinois Institute of Technology, Chicago, IL, USA.
  • Charlotte K Boughton
    Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.
  • Marc D Breton
    Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA.
  • Eyal Dassau
    Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, Massachusetts, USA.
  • Greg Forlenza
    Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
  • Robert J Henderson
    Jaeb Center for Health Research, Tampa, Florida, USA.
  • Roman Hovorka
    Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.
  • David M Maahs
    Department of Pediatrics, Stanford University, Stanford, CA, USA.
  • Medha Munshi
    Joslin Diabetes Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • Helen Murphy
    Kings College London, London, United Kingdom.
  • Sarit Polsky
    Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
  • Richard Pratley
    Advent Health Translational Research Institute, Orlando, Florida, USA.
  • Melissa S Putman
    Diabetes Research Center, Mass General Hospital, Boston, Massachusetts, USA.
  • Viral N Shah
    Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
  • Leah M Wilson
    2 Department of Medicine, Division of Endocrinology, Harold Schnitzer Diabetes Health Center Oregon, Health & Science University, Portland, OR, USA.
  • Howard Zisser
    Santa Barbara, CA, USA.
  • Laya Ekhlaspour
    Division of Pediatric Endocrinology, University of California San Francisco, San Francisco, California, USA.

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