Revolutionizing diabetes care: new insulin pump and algorithm-based software for automatic insulin delivery

Type 1 diabetes mellitus is characterized by the destruction of pancreatic beta cells, which leads to inadequate insulin production and substantial health risks. Diabetes is also a common risk factor for cardiovascular disorders1. This article investigated the transformative effects of insulin pumps and continuous glucose monitors (CGM) on type 1 diabetes (T1D) management. These advancements have paved the way for automated insulin delivery (AID) systems driven by algorithmic controllers2. The incorporation of these technologies enables tailored insulin delivery based on real-time glucose sensor readings, fundamentally reshaping the approach to T1D management3. This integration empowers the customization of insulin administration through real-time glucose readings, fundamentally revolutionizing the management of T1D4. The significance of AID becomes apparent when considering the intricate dosing choices that individuals with T1D use to maintain their optimal blood sugar levels. Inherent variability in insulin sensitivity and glucose levels results in considerable day-to-day fluctuations, which imposes a substantial management challenge. Research indicates that AID systems have the potential to effectively address these challenges, thereby mitigating the burden of illness and improving glycemic outcomes5. Modern insulin pumps incorporate advanced algorithms that dynamically adjust insulin delivery based on real-time glucose sensor readings to maintain blood sugar levels within a specific target range6. Notably, a comparative study investigating continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) demonstrated positive results, indicating improved lifestyle flexibility and reduced stress related to hypoglycemia among CSII users7. Moreover, leading endorsements from reputable bodies such as American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD) support the consideration of insulin pump therapy because of its proven safety and effectiveness8. Automatic insulin delivery systems incorporate a comprehensive range of physiological and behavioral data, facilitating precise predictions that are particularly focused on factors such as dietary intake and physical activity9. Notably, previous studies have consistently revealed that closed-loop systems significantly enhance the regulation of glucose levels, thereby reducing the occurrence of hypoglycemic events. These improvements extend throughout the day and night, contributing to positive overall glycemic effects10. The heightened precision in glycemic control achieved through AID systems provides tangible benefits for disease management and quality of life. A comparison between traditional glucose monitoring and insulin injections underscores the superiority of AID in improving outcomes11. Additionally, the user experience and convenience associated with these technologies are worth highlighting. Patients and their caregivers hold high expectations for AID systems to offer a self-sustaining, 'artificial pancreas' experience that effectively mitigates the daily challenges posed by diabetes12. The satisfaction experienced by users can be attributed to a range of factors, including the meticulous design of the devices, the accuracy of the data provided, and the reduction in nocturnal alarm disruptions. This culmination of positive elements leads to better diabetes-related outcomes and a notable reduction in stress levels12,13. In 2019, researchers introduced the Advanced Hybrid Closed Loop (AHCL) insulin pump, designed to maintain glycemic levels within a defined range. Early investigations into AHCL's application among adults and adolescents with T1D have shown remarkable achievements in glycemic control, coupled with high levels of patient satisfaction. The integration of AID systems has exhibited both safety and efficacy, aiding individuals with diabetes in achieving their long-term glycemic objectives while mitigating the risk of hypoglycemia. Multiple randomized controlled trials and real-world assessments have provided substantial evidence of this efficacy14. Aggregate findings drawn from extensive cohort studies and nationwide registries highlight the potential of insulin pump utilization to augment cardiovascular risk factors such as hypertension and dyslipidemia. Furthermore, individuals who use insulin pumps display promising indications of reduced arterial stiffness and improved cardiac performance metrics. The cumulative insights gained from comprehensive longitudinal studies and meticulous case–control analyses have yielded a compelling connection between pump adoption and decreased incidence of cardiovascular events, thereby contributing to a reduction in the occurrence of cardiovascular disease and an overall decrease in mortality rates15. The horizon of diabetes technology holds both promise and potential. Notable progress has occurred across various realms, exemplified by advancements in Continuous Glucose Monitoring (CGM). These innovations are characterized by heightened accuracy and increased affordability, rendering CGM more accessible. Artificial Pancreas Systems, attuned to fine-tuning insulin delivery based on CGM data, have shown remarkable potential. Added to this landscape is a smart insulin pen that embeds sensors to empower patients in the effective management of insulin intake. In parallel, the evolution of non-invasive glucose monitoring technologies is underway, with the aim of simplifying glucose monitoring processes and enhancing convenience. These advancements collectively hold the transformative potential to amplify diabetes management, enriching the quality of life of individuals with diabetes16. Statins and fibrates have been traditionally used to control dyslipidemia in diabetes17. Furthermore, a wave of hybrid systems has been poised to enter the market, further enriching the available options. Among these, DBLG1 (Diabeloop, Grenoble, France) stands out, having secured the Conformité Européene (CE) mark for deployment among adults with T1D. Omnipod Horizon (Insulet, Billerica, Massachusetts, USA) and insulin-only iLet (Beta Bionics, Boston, Massachusetts, USA) are actively undergoing clinical trials. Noteworthy in the DIY landscape, Tidepool, a nonprofit software entity behind Loop, has engaged with the United States Food and Drug Administration (FDA). Their endeavor aimed to establish Loop as an FDA-regulated mobile application, which has garnered backing from the Juvenile Diabetes Research Foundation (JDRF). The emergence of open-source AID systems has implications for the well-being of children and adolescents with T1D. This insight serves as an educational tool to foster awareness of the potential psychological and quality-of-life effects linked to open-source AID15. The convergence of a new insulin pump and algorithm-based software marks a pivotal step in AID, offering a spectrum of benefits that elevate diabetes management. Precise insulin dosing augments glycemic control and reduces the risk of glucose fluctuations. The adaptive algorithm ensures real-time insulin adjustments and effectively addresses dynamic needs. User-friendly interfaces simplify engagement and promote continuous monitoring. Recognizing the potential of this innovation, further research and wider integration are paramount. By embracing such advancements, diabetes care can undergo a transformative shift, resulting in improved patient outcomes, decreased complications, and an enhanced quality of life. Therefore, fostering the adoption of innovative technologies is vital to advancing diabetes management and enriching the well-being of individuals with diabetes. Ethical approval None. Consent None. Sources of funding None. Author contribution A.A. and B.T.: conceptualization, funding acquisition, and project administration; N.R. and K.F.: investigation; A.A. and K.F.: resources and supervision; N.R.: software; A.A.: visualization; I.T. and N.-e-S.A.: writing – original draft; A.A., I.T., and N.-e-S.A.: writing – review and editing. All authors were involved in the validation and the final approval of the manuscript for publication. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Nahid Raufi. Provenance and peer review Not commissioned, externally peer-reviewed. Data availability statement None.