Skip to main content
        
        U.S. flag
                An official website of the United States government
                    Here’s how you know
                Here’s how you know**Official websites use .gov**
                        
                        A **.gov** website belongs to an official government organization in the United States.
            **Secure .gov websites use HTTPS**
                        
                        A **lock** (
                        Locked padlock icon
                        ) or **https://** means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.Search
    Menu

        Search for Information from NIDDK
            
            Entire Site
                Research & Funding
                Health Information
                News
                About NIDDKSearch

Home
            Research & Funding
                                Expand Research & Funding
                                Current Funding Opportunities
                                                    Research Programs & Contacts
                                                    Human Subjects Research
                                                    Funding Process
                                            Research Training & Career Development
                                                    Funded Grants & Grant History
                                                    Research Resources
                                            Research at NIDDK
                                                    Technology Advancement & Transfer
                                                    Meetings & Workshops
                        Health Information
                                Expand Health Information
                                Health Topics
                                                                                                    Diabetes
                                                    Digestive Diseases
                                                    Kidney Disease
                                                    Weight Management
                                                    Liver Disease
                                                    Urologic Diseases
                                                    Endocrine Diseases
                                                    Diet & Nutrition
                                                    Blood Diseases
                                                    Diagnostic Tests
                                            La información de la salud en español
                                                    Health Statistics
                                                    Healthy Moments Radio Broadcast
                                                    Clinical Trials
                                            For Health Professionals
                                                    Diabetes Discoveries & Practice Blog
                                                    Community Health & Outreach
                        News
                                Expand News
                                News Archive
                                                    For Reporters
                                            Meetings & Workshops
                                                    Media Library
                                            Follow Us
                        About NIDDK
                                Expand About NIDDK
                                Meet the Director
                                                    Offices & Divisions
                                                    Staff Directory
                                                    Budget & Legislative Information
                                            Advisory & Coordinating Committees
                                                    Strategic Plans & Reports
                                                    Research Areas
                                                    FAQs
                                            Jobs at NIDDK
                                                    Visit Us
                                                    Contact Us Home
                    Health Information
                    For Health Professionals
                    Diabetes Discoveries & Practice Blog
                    How Can an Artificial Pancreas Help People with Type 1 Diabetes?
     Diabetes Discoveries & Practice Blog


    How Can an Artificial Pancreas Help People with Type 1 Diabetes?
    
    Oct. 11, 20230 Comments
            New Technologies
                    Type 1 Diabetes
                    Patient Self-ManagementAn artificial insulin delivery systemAutomated insulin delivery systems, also called artificial pancreas, can improve glycemic outcomes and make daily self-care easier for people with type 1 diabetes.

    Automated insulin delivery (AID) systems, also called artificial pancreas, help people with type 1 diabetes automate tasks such as monitoring their blood glucose and taking insulin. AID systems improve glycemic outcomes and quality of life for many people, but their high cost and other barriers prevent more widespread use. Sue Brown, MD, professor of endocrinology at the University of Virginia School of Medicine, describes how AID systems can help patients manage diabetes and what’s ahead for this innovative technology.
**Q: What is an artificial pancreas?**
**A:** Many people have used the term “artificial pancreas,” but my preferred term is “automated insulin delivery,” or AID. You may also see the term “closed-loop system.”
These systems automatically determine insulin requirements and adjust insulin delivery to meet the current needs of a person with type 1 diabetes. Most AID systems do this about every 5 minutes to keep people in their blood glucose target range as much as possible. These systems also reduce the risk of hyperglycemia and hypoglycemia.
These systems have three components that work together and communicate using Bluetooth technology
a continuous glucose monitor (CGM) that measures the person’s blood glucose level
    an insulin pump that delivers insulin to the person’s body
    an algorithm that collects data from the CGM, calculates the person’s current insulin needs, and signals the pump to change or maintain insulin deliveryAID systems use current and historical information about insulin delivery, blood glucose targets, and actual blood glucose values. All of that information goes into calculations the system performs to determine how much insulin is required in the moment.
There are many systems with different configurations of devices and algorithms. This year alone, the U.S. Food and Drug Administration (FDA) has approved three new algorithms for use in AID systems. Most systems are for people age 6 and older with type 1 diabetes, but the FDA has approved at least one system for children as young as 2. Artificial pancreas systems have been studied in people with type 2 diabetes who need insulin, but they are not yet FDA-approved for this population.
**Q: Why is this technology critical for people with type 1 diabetes? How can it improve diabetes management compared with CGMs or insulin pumps alone?**
**A:** Many, if not most, people with type 1 diabetes do not meet the American Diabetes Association (ADA) goals for glycemic outcomes. This is especially true for adolescents and young adults. It is clear that different strategies are needed. AID is one such solution to improve outcomes.
We have lots of data showing that AID systems—regardless of the specific algorithm or configuration—consistently help people meet glycemic goals in clinical trials, as well as in real life. That means increasing time in range by about 2.5 hours per day on average, lowering hemoglobin A1C levels by 0.3% to 0.5%, and decreasing the risk of hypoglycemia. Of course, the exact numbers vary by individual. Notably, people see the most benefit from these systems overnight. This is a vulnerable time period for many people with type 1 diabetes because of the risk of hypoglycemia while sleeping.
The pivotal clinical trials compared AID systems to usual care. In some cases, participants used an insulin pump or CGM without an algorithm.
The beauty of AID is that it further automates the process of daily self-care and improves glycemic outcomes at the same time. This often means a better quality of life. Studies show that patients with type 1 diabetes and their caregivers may experience reduced anxiety and distress. The systems also may reduce fear of hypoglycemia among parents of children with type 1 diabetes, leading to better sleep.
**Q: Which patients can benefit most from an AID system?**
**A:** There’s yet to be a population with type 1 diabetes that hasn’t benefited when using AID. There have been studies in very young children (ages 2 to 5 years), older children, adolescents, and adults. Across those age ranges, we’ve seen a significant improvement in glycemic measures such as A1C level and time in target range for glucose. These improvements occurred in people of different incomes and racial and ethnic groups.
That doesn’t mean everyone in a clinical trial had the same outcomes. Often, participants who started out with very high A1C levels or lower time in range had the biggest improvements. But they didn’t necessarily attain as low an A1C or as high a time in range as those who started out at a lower A1C or higher time in range.
Among age groups, AID systems especially help adolescents with higher A1C levels and lower time in range. These automated systems can compensate when someone might miss a meal-time insulin bolus, for example. AID can decrease the burden of making clinical management decisions every day.
**Q: What are the limits of AID systems?**
**A:** The current FDA-approved devices perform better if users provide some sort of meal announcement. However, the person or their caregiver doesn’t have to know how to count carbs to use these systems. Instead, they can input a fixed amount of carbs for a meal-time insulin bolus as one method to make these systems easier to use. If they did not bolus for a meal, the AID systems can compensate to some degree. One of the newer systems decreases the burden still more by allowing users to indicate if they’re eating a usual meal or one that is bigger or smaller.
AID systems do not perform as well for exercise. There’s still quite an effort to manage the impact of exercise on blood glucose levels and resulting insulin needs. The systems often have a setting that can be adjusted to account for exercise, but this area is still a challenge.
In terms of the system components, users must understand that the insulin pump infusion set—the thin plastic tube that connects the insulin pump to the person’s body—can fail and how to detect that. They must also know when a CGM may not be accurate and how to handle that. Health care professionals can teach patients these skills along with how to use the AID system.
In a perfect world, we’d love an artificial pancreas that requires less management, where you can “set it and forget it,” but we’re not quite there yet.
**Q: What percentage of people with type 1 diabetes use AID? What barriers prevent wider use of this technology?**
**A:**We don’t know what percentage of people with type 1 diabetes use AID. We do know that the use of diabetes care technology, particularly CGMs, has risen significantly.
There are many factors to consider in deciding if AID is right for a patient. One of them is whether a person wants to wear an on-body device or not.
If a patient does want to get an AID system, cost and access are looming issues. The cost of AID systems varies but can be several thousand dollars. They are usually covered by insurance, but there are all kinds of variations in coverage. Sometimes the pump is covered but the CGM is not. I often write letters of appeal for patients whose health plans have denied coverage. Some manufacturers offer financial assistance programs. Still, the cost can put this technology out of reach for some patients. On top of that are the ongoing costs of insulin and supplies for CGMs and insulin pumps.
It appears that there are socioeconomic and racial and ethnic disparities in the use of diabetes technologies. Compared with non-Hispanic White patients, patients from other racial and ethnic groups are less likely to be on either a CGM or an insulin pump. I don’t know yet if that applies to AID systems. There are likely many reasons for these disparities, and I do want to highlight the issue of potential bias from health care professionals. By that I mean that patients who could benefit may not be offered an AID device or given assistance or encouraged to obtain or manage these systems, which is an important barrier that needs to be addressed.
**Q: How can health care professionals learn about artificial pancreas systems and train patients to use them?**
**A:**The first step is to keep abreast of changing technology. The various AID systems have their differences. Health care professionals must understand them to help patients select and use AID properly, according to clinical guidelines for initiating artificial pancreas systems, which were developed by an international panel. These guidelines include recommendations for training and education.
Technical training in AID should occur alongside education about overall diabetes management. Some may prefer to start with a CGM or insulin pump first, but I find that many who have never used diabetes technology can jump right into AID use.
Manufacturers of artificial pancreas systems also provide in-person and online training for health care professionals. Professional organizations also offer training. The PANTHER program run by the University of Colorado’s Barbara Davis Center for Diabetes has device fact sheets, a device-comparison chart, and more on its website.
**Q: What is the future of artificial pancreas research? What gaps in knowledge remain? What technical improvements can be made?**
**A:**There are a lot of persistent challenges in AID research. As I mentioned, cost and access are barriers. Another issue is managing postprandial hyperglycemia, or high blood glucose that occurs after meals. That’s related in part to how subcutaneous insulin acts inside the body, which is quite slow. Researchers are trying to see if some medications used for type 2 diabetes, such as GLP-1 receptor agonists, could be add-ons that help with postprandial hyperglycemia.
Also, exercise has a lot of complex effects on glycemia. There are a lot of reasons for that. One is that subcutaneous insulin action in the body is prolonged and doesn’t turn off quickly enough when needed during exercise. We need ways for AID systems to better regulate insulin to mitigate the risk of hypoglycemia after exercise.
Patients still have a lot of interactions with the AID system. Several research groups are working to lower this burden by creating algorithms that either do not require or minimize the need for insulin boluses to be given for corrections or meals.
Other researchers are looking at insulins with different actions in the body or different methods of insulin delivery. Dual-hormone systems that administer insulin along with other hormones such as glucagon, which is used to treat hypoglycemia, are also being studied.
Finally, we need larger and longer-term trials of AID systems to better understand the systems’ ability to provide long-term benefits for metabolic control.
**Do you offer artificial pancreas systems to your patients? Share below in the comments.**
Dr. Sue BrownAbout the Expert
        Sue Brown, MD, is an endocrinologist who researches treatment options for people with diabetes, with a focus on automated insulin delivery systems. As a faculty member at the University of Virginia Center for Diabetes Technology and the Division of Endocrinology, she has helped develop and evaluate several AID systems. She is a principal investigator for three NIDDK grants that aim to further optimize AID systems to improve the lives of people with type 1 diabetes.Subscribe
    Sharethis page
        
Print
    Facebook
    X
    Email
    
    More Options
    
    WhatsApp
    LinkedIn
    Reddit
    Pinterest
    
    Copy Link
*Newer Post:*
                How Can You Help Patients Prevent Diabetes Complications?
            *Older Post:*
                How Does Stigma Affect Patients with Overweight, Obesity, or Diabetes?    Related Posts
        A New Artificial Pancreas System for Children with Type 1 DiabetesHow Can You Help Patients Use New Diabetes Technologies?Comments
        Click to load comments
            Loading comments...
    Blog Tools
            Subscribe
        Subscribe to get blog updates.
                SubmitSharethis page
    
Print
    Facebook
    X
    Email
    
    More Options
    
    WhatsApp
    LinkedIn
    Reddit
    Pinterest
    
    Copy LinkSearch
    SearchAbout   
        **Diabetes Discoveries and Practice Blog**
Dialogue with thought leaders on emerging trends in diabetes careTags
            Patient Communication
                        64
                    Research Advancements
                        45
                    Complications of Diabetes
                        35
                    Medication and Monitoring
                        29
                    Practice Transformation
                        25
                    Diabetes Prevention
                        24
                    Patient Self-Management
                        22
                    Obesity and Weight Management
                        20
                    Social Determinants of Health
                        19
                    New Technologies
                        17
                        More tags
                    Diabetic Kidney Disease
                        15
                    Type 1 Diabetes
                        15
                    Nutrition
                        12
                    Shared Decision-Making
                        12
                    Community Health
                        8
                
                    Fewer tagsArchive
        
            April 2024
                        1
                    March 2024
                        1
                    Feb. 2024
                        1
                    Jan. 2024
                        1
                    Dec. 2023
                        1
                    Nov. 2023
                        1
                        More months
                    Oct. 2023
                        1
                    Aug. 2023
                        1
                    July 2023
                        1
                    June 2023
                        2
                    May 2023
                        1
                    April 2023
                        1
                    March 2023
                        1
                    Feb. 2023
                        1
                    Jan. 2023
                        2
                    Dec. 2022
                        1
                    Nov. 2022
                        2
                    Oct. 2022
                        2
                    Sept. 2022
                        2
                    Aug. 2022
                        3
                    July 2022
                        2
                    June 2022
                        2
                    May 2022
                        2
                    April 2022
                        2
                    March 2022
                        2
                    Feb. 2022
                        2
                    Jan. 2022
                        2
                    Dec. 2021
                        2
                    Nov. 2021
                        1
                    Oct. 2021
                        2
                    Sept. 2021
                        2
                    Aug. 2021
                        2
                    July 2021
                        2
                    June 2021
                        3
                    May 2021
                        2
                    April 2021
                        2
                    March 2021
                        2
                    Feb. 2021
                        2
                    Jan. 2021
                        1
                    Dec. 2020
                        2
                    Nov. 2020
                        2
                    Oct. 2020
                        4
                    Sept. 2020
                        5
                    Aug. 2020
                        4
                    July 2020
                        3
                    June 2020
                        2
                    May 2020
                        2
                    April 2020
                        1
                    March 2020
                        2
                    Feb. 2020
                        3
                    Jan. 2020
                        2
                    Dec. 2019
                        3
                    Nov. 2019
                        2
                    Oct. 2019
                        2
                    Sept. 2019
                        3
                    Aug. 2019
                        3
                    July 2019
                        3
                    June 2019
                        2
                    May 2019
                        4
                    April 2019
                        2
                    March 2019
                        2
                    Feb. 2019
                        1
                    Jan. 2019
                        2
                    Dec. 2018
                        2
                    Nov. 2018
                        4
                    Oct. 2018
                        4
                    Sept. 2018
                        2
                    Aug. 2018
                        5
                    July 2018
                        3
                    June 2018
                        4
                    May 2018
                        5
                    April 2018
                        4
                    March 2018
                        3
                    Feb. 2018
                        4
                    Jan. 2018
                        3
                    Dec. 2017
                        3
                    Nov. 2017
                        4
                    Oct. 2017
                        2
                    Sept. 2017
                        4
                
                    Fewer monthsDisclaimer
        We welcome comments; all comments must follow ourcomment policy.
Blog posts written by individuals from outside the government may be owned by the writer and graphics may be owned by their creator. In such cases, it is necessary to contact the writer, artist, or publisher to obtain permission for reuse. Contact Us
**Hours:** 8:30 a.m. to 5 p.m. ET, Monday - Friday**Email:** healthinfo@niddk.nih.gov**Phone:** +1-800-860-8747**TTY:** +711
Chat
Live Chat Available8:30 a.m - 5 p.m. ETMonday - Friday
Follow Us
LinkedIn
X
Facebook
YouTube
InstagramNIH... Turning Discovery Into Health ®
Privacy Policy
    Freedom of Information Act
    Accessibility
    Disclaimers
    Copyright
    Vulnerability Disclosure Policy
Site Map
    For Staff Only
    Get Email Updates
U.S. Department of Health and Human Services
    National Institutes of Health