(P605) Defining the Automated Insulin Delivery Continuum: User Engagement and Settings Adjustment

Innovations in insulin delivery with glucose monitoring integration have the goal of improving glycemia to be closer to that of people without diabetes and have progressed from low-glucose and predictive low-glucose suspension of insulin delivery when sensor glucose crosses or is predicted to cross the low threshold level, to algorithm-driven semi-automated insulin delivery based on sensor glucose with manual meal and correction boluses. Ongoing advances include autocorrection boluses, meal detection, as well as offering multiple glucose target set points. One AID system, the iLet bionic pancreas (BP), Beta Bionics, Concord, Massachusetts, uses 3 adaptive closed-loop algorithms to provide fully autonomous insulin delivery (FAID) automatically titrating all therapeutic insulin, including basal, correction, and prandial insulin. The system is initiated with only the user’s body weight, then the system perpetually learns and automatically refines dosing without the need for manually calculating, programming, and adjusting insulin therapy settings. Qualitative meal announcements versus precise carbohydrate counting are required to autonomously determine prandial insulin. FAID is the next stage in AID development. As AID systems evolve and continue to advance, it is important to be able to clearly distinguish how the various system algorithms work. Confusion or misconceptions regarding the various algorithms, in some cases with trademark names, point to the need for a standardized way to define and discuss how algorithms differ and the implications for end users and the clinicians that care for them. To this end, the poster describes an automated insulin delivery continuum for both users of the system (level of engagement) and clinicians (the need to calculate and adjust system settings based on the system’s adaptive capability). Implications for expanding technology access to a broader population and through primary care versus only in endocrinology, as systems progress through the continuums, are also discussed. Case studies are presented to illustrate the application of the adaptive fully autonomous insulin dosing approach.