Clinical Approaches to Managing Glycemia with the iLet Dosing Decision Software

The iLet Bionic Pancreas (iLet) is an FDA-approved automated insulin delivery system designed to manage glycemia through use of the iLet Dosing Decision Software. It uses real-time glucose data from a compatible continuous glucose monitor to automatically adjust and deliver insulin without the need for manually calculating, programming, and adjusting insulin therapy settings. The iLet autonomously determines all insulin dosing. For this context, autonomous insulin delivery is referring to the fact that all system dosing is independently determined by the system without requiring baseline clinician determined settings, but the system does require qualitative meal announcements by the user. It is shifting the paradigm for glycemic management toward simplification and expanding technology access to a broader population. The shift from adjusting settings to behavioral education represents a return to the art of medicine for the clinician. While the clinician no longer needs to adjust settings, they are not powerless when faced with dysglycemia. Clinical interventions are education focused. In this review, we provide clinical guidance for diabetes management with the iLet Dosing Decision Software (Beta Bionics, Irvine, CA, United States). Other systems with similar autonomous functionality and learning capability will likely be available in the coming years.