Background: Automated insulin delivery (AID) systems have the ability to dramatically improve glycemic control for patients with type 1 diabetes (T1D) while reducing burden and hypoglycemia. Early versions of these systems are hybrid closed loop (HCL) requiring user input of carbohydrate intake and often benefiting from user-initiated corrections and proper tuning. Such systems are thus not plug-and-play but rather complex medical aids for which users benefit from proper training and onboarding to optimize device use and benefit.
Methods: I will review the published literature on HCL device training and clinical adoption of this technology across different clinical centers. I will also present the HCL implementation protocols from our large clinical center as well as those proposed for emerging HCL clinical trials.
Results: Multiple reports have demonstrated user attrition of HCL use with early generation devices. Increased burden has been postulated as the primary driver. Clinical trials on newer generation systems have indicated the potential for sustained use with improved device builds. Multiple system designs are emerging, each of which may require different forms of user training and onboarding.
Discussion: New AID systems will continue to reduce device burden while improving overall glycemic control. Proper understanding of these devices is essential to drive appropriate patient training and system onboarding.