Diabetes Without Math as Automation Advances: A Shifting Clinical Paradigm

In this perspective we provide an overview of the recent advances in automated insulin delivery (AID) technologies including adaptive closed-loop algorithms, enabling fully autonomous insulin dosing with meal announcements. This is leading to a paradigm shift in insulin management for both people with diabetes and clinicians, potentially expanding diabetes technology access to a broader population. We discuss the potential for these advances to reduce the cognitive burden of daily diabetes self-management for those on insulin therapy as well as bringing new considerations including psychological adjustments regarding transferring management to an algorithm. We include key themes identified in a recent qualitative study with users of an advanced AID system: dealing with perceived lack of control and developing trust, psychological and behavioral changes in diabetes management and daily routine, and ongoing challenges including the physical burden of pump therapy. Finally, we discuss the implications of technology advances on clinical practice and how clinicians interact with and support people with diabetes using these advanced tools. This includes redefining success that may involve achieving an acceptable level of management for the individual with less effort while improving quality of life. As automation takes on more of the technical burden, clinicians are empowered to engage more deeply in the overall health and life goals of their patients. As automation advances, we are moving toward simplification of diabetes management.