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Automated Insulin Delivery: Benefits, Challenges, and Recommendations. A Consensus Report of the Joint Diabetes Technology Working Group of the European Association for the Study of Diabetes and the American Diabetes Association

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Sherr, Jennifer L., Heinemann, Lutz, Fleming, G. Alexander, Bergenstal, Richard M., Bruttomesso, Daniela, Hanaire, Hélène, Holl, Reinhard W., Petrie, John R. +2 more·2022·Diabetes Care
DOI 10.2337/dci22-0018
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Abstract

A technological solution for the management of diabetes in people who require intensive insulin therapy has been sought for decades. The last 10 years have seen substantial growth in devices that can be integrated into clinical care. Driven by the availability of reliable systems for continuous glucose monitoring, we have entered an era in which insulin delivery through insulin pumps can be modulated based on sensor glucose data. Over the past few years, regulatory approval of the first automated insulin delivery (AID) systems has been granted, and these systems have been adopted into clinical care. Additionally, a community of people living with type 1 diabetes has created its own systems using a do-it-yourself approach by using products commercialized for independent use. With several AID systems in development, some of which are anticipated to be granted regulatory approval in the near future, the joint Diabetes Technology Working Group of the European Association for the Study of Diabetes and the American Diabetes Association has created this consensus report. We provide a review of the current landscape of AID systems, with a particular focus on their safety. We conclude with a series of recommended targeted actions. This is the fourth in a series of reports issued by this working group. The working group was jointly commissioned by the executives of both organizations to write the first statement on insulin pumps, which was published in 2015. The original authoring group was comprised by three nominated members of the American Diabetes Association and three nominated members of the European Association for the Study of Diabetes. Additional authors have been added to the group to increase diversity and range of expertise. Each organization has provided a similar internal review process for each manuscript prior to submission for editorial review by the two journals. Harmonization of editorial and substantial modifications has occurred at both levels. The members of the group have selected the subject of each statement and submitted the selection to both organizations for confirmation.

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  • Current algorithms are primarily responsive to immediate glycemic changes and may not fully compensate for delayed carbohydrate absorption, especially from meals rich in fat and protein that can induce delayed hyperglycemia.

    “However, current algorithms are primarily responsive to immediate glycemic changes and may not fully compensate for delayed carbohydrate absorption, especially from meals rich in fat and protein that can induce delayed hyperglycemia [131, 132, 158].”

    From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [131]

    The Patient Perspective section says AID systems increase insulin delivery in response to elevated glucose and that meal bolusing should account for proteins and fat. The Limitations of AID Systems section also describes sensor lag and the need for manual meal boluses. Neither section establishes that fat- and protein-rich meals delay carbohydrate absorption and cause delayed hyperglycemia that current algorithms cannot fully compensate for. (LLM, conf=0.85)

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  • Digital innovations in glucose sensing and insulin delivery have improved glycemic management in diabetes and offer particular advantages in patients with DGP, where delayed and variable carbohydrate absorption leads to erratic glycemic excursions.

    “Digital innovations in glucose sensing and insulin delivery have improved glycemic management in diabetes and offer particular advantages in patients with DGP, where delayed and variable carbohydrate absorption leads to erratic glycemic excursions [131, 132].”

    From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [131]

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Research works printed but not linked: 2

  1. Elleri D, Allen JM, Tauschmann M, et al. Feasibility of overnight closed-loop therapy in young children with type 1 diabetes aged 3- standard insulin strength. BMJ Open Diabetes Res Care 2014;2:e000040
  2. Herman A, Aerts O, Baeck M, et al. Allergic contact dermatitis caused by isobornyl acrylate in FreestyleV R Libre, a newly introduced glucose sensor. Contact Dermat 2017;77:367-373

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Authors
Sherr, J. L., Heinemann, L., Fleming, G. A., Bergenstal, R. M., Bruttomesso, D., Hanaire, H., Holl, R. W., Petrie, J. R., Peters, A. L., & Evans, M.
Affiliations
  • Yale University (US)
  • 2Science & Co, Kaarst, Germany
  • 3Kinexum, Harpers Ferry, WV
  • HealthPartners (US)
  • University of Padua (IT)
  • Centre Hospitalier Universitaire de Toulouse (FR)
  • Universität Ulm (DE)
  • University of Glasgow (GB)
  • University of Southern California (US)
  • University of Cambridge (GB)
Corresponding author
Evans, Mark
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2022-10-06
Volume
45
Issue
12
Pages
3058-3074
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dci22-0018
OpenAlex
W4302759931
Cited by
136
References
97
Citations by year
2026: 45 · 2025: 42 · 2024: 31 · 2023: 16 · 2022: 2
FWCI
16.87
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/journals/pages/license (vor)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • American Diabetes Association
  • European Association for the Study of Diabetes
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords
artificial pancreas, type 1 diabetes, continuous glucose monitoring, insulin pump, intensive insulin therapy, device safety, regulatory approval, diabetes technology
MeSH terms
Blood Glucose, Diabetes Mellitus, Type 1, Glucose, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Technology, Blood Glucose Self-Monitoring, Consensus, Insulin, Regular, Human

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