Hybrid Closed Loop Systems Still Require User Intervention

Remember, even with driver-assist, you can’t fall asleep at the wheel.

 

With any hybrid closed loop system, the user remains responsible for the majority of their diabetes self-management, including:

Counting carbs and bolusing for food in a timely manner.

Making adjustments for physical activity – which may include adjustments to insulin and food.

Managing the insulin infusion mechanism - including timely infusion set and cartridge changes, site rotation, keeping insulin from spoiling, and removing air from the system.

Responding to system alarm & alerts in a timely manner.

Altering insulin delivery for life events – such as stress, illness, travel, hormone changes, and medications that affect glucose levels.

Having a backup plan to put into place in the event any part of the HCL system is not functioning properly.

 

Interoperability

As we discussed earlier, an HCL system can only function when supplied with continuous glucose data.  It needs this data to make automated adjustments to the pump’s insulin delivery.

 

Some systems only utilize one specific type of CGM, while others are designed to work with a variety of CGMs.  The ability to connect with a variety of devices is called “inter-operability.”  Eventually, users of an HCL system may be able to custom-build their own system by choosing from a menu of pumps, CGMs and algorithms that all can work together.

Some systems are more versatile than others Some systems work with multiple CGMs The future: users will be able to choose from a variety of pumps, CGMs and algorithms to custom-build their own system

 

Interoperability Today

In terms of CGMs, here is what we have so far in the way of interoperability.

 

The Dexcom G6 CGM transmits data into the Tandem T:slim X2 insulin pump’s Basal IQ and Control IQ algorithms.  It also provides data for the do-it-yourself Loop app, Open APS, and Android APS systems.  Dexcom G6 will also be able to share data with the OmniPod Horizon and BetaBionics hybrid closed loop systems once they launch.

The Abbott Libre CGM is not connected to any hybrid closed loop systems at present, but plans are underway to connect it to the Tandem system, as well as Bigfoot Biomedical’s system once it launches.

The Medtronic Guardian 3 CGM currently links only with the Medtronic 630G and 670G hybrid closed loop systems.  However, the older Medtronic Enlite sensor can be used with the do-it-yourself Loop and Open APS HCL systems.

The Senseonics Eversense CGM does not currently connect with any hybrid closed loop systems, but it does integrate data with the InPen insulin pen from Companion Medical... as does the Dexcom G6. 

 

Summary

In summary, we discussed the current state of continuous glucose monitoring and the benefits it can offer in day-to-day diabetes management. We took a look at the various CGM options and explained the essential role they play in automated insulin delivery. And finally, we explored the concept of interoperability, whereby users can select the devices of their choice to build a hybrid closed loop system. The future will see many advances in the area of CGM, insulin pump and algorithm interoperability (not to mention battery life), and many new devices to support this technology. It will be an exciting time, one that brings with it increased ease-of-use and flexibility for the person with insulin-dependent diabetes, as well as an increased quality of life.

Today:   Some devices already are beginning to work together   Some functions are automated   In the future:   Standardized interfaces will allow more devices to work together   Most functions will be automated   Better battery life