Many people living with type 1 diabetes (T1D) use automated insulin delivery (AID) systems to help manage blood glucose levels. AID systems include an insulin pump linked to a continuous glucose monitor (CGM) via specially designed software. They take glucose readings every few minutes and then calculate and adjust insulin delivery to help keep your glucose within target range.  

Today’s AID systems require you to “announce” your meals. Doing this entails counting carbs and delivering an extra dose, or bolus, of insulin. One exception to this is the iLet Bionic Pancreas, which adjusts insulin delivery automatically after a “carb estimate” is entered.  

For many people, bolusing for meals is a nuisance and is sometimes overlooked or forgotten. When this happens, it can lead to a rapid rise in glucose levels. In an effort to find an alternative solution, researchers have developed, and are studying, “unannounced meal management” technology. This new functionality would allow you to skip meal announcements without compromising glucose management.  

 

What is unannounced meal management technology? 

It is an algorithm that could help AID systems recognize and respond more quickly to unannounced meal-related glucose changes. In other words, when your CGM detects a meal-related spike in glucose, it would automatically adjust insulin settings to help keep glucose in target range.  

With AID systems responding to after-meal changes, eating would be a decision-free, hands-off process. Meaning, you could simply eat without telling your AID system. 

The technology is under development by Diabeloop, a company that makes and distributes AID system software in Europe. The software is currently only approved for people 18 years old and up and is not yet available in the U.S. 

 

What is involved in the Diabeloop study? 

This study aims to test the function of unannounced meal management technology in preteens and teens living with T1D. It will include about 50 people ages 12–17 years in France, Belgium, and Germany. They will go about their normal daily lives during the study. Each person will use an AID system that includes: 

  • a Dexcom G6 CGM,  
  • a Terumo MEDISAFE WITH patch pump, and  
  • Diabeloop software.  

The participants will use the AID systems for 8 weeks. For 4 weeks, they will announce their meals while using the system, and for another 4 weeks, they will not. The researchers will measure the time the participants’ glucose levels are in target range.  

Then, they will compare time in the range between the two periods: with and without meal announcements. If the time in range is similar in both periods, then announcing meals might not be necessary when using this system. The researchers will also look for extremely high or low glucose levels to ensure the system is safe. The study is underway, and we hope to learn the results this summer. 

   

Why focus on teens? 

Insulin management can be especially difficult during adolescence. One reason is biology: Glucose levels can become more erratic as insulin resistance increases during puberty. Also, as teens become more independent, they often take on more responsibility for managing T1D themselves.  

As a result, this can lead to more challenges in managing glucose levels. Some teens report difficulties managing glucose levels at school or in social settings. Only about one in five people with T1D in the U.S. who are 18 years old or younger meet the average blood glucose (BG) level recommended by the American Diabetes Association. Average BG levels that exceed this recommendation can increase the risk for diabetes-related complications, either now or in the future. 

Diabeloop held a workshop where people spoke about managing diabetes during their teen years. Participants said that forgetting to bolus was one of their biggest challenges. In fact, 10% of teens with T1D have reported missing mealtime boluses. These missed boluses can have undesirable effects. Forgetting just four mealtime boluses in a week can measurably increase a person’s average BG level.  

For these reasons, unannounced meal management could be particularly beneficial for teens.   

 

What is the ultimate goal of this technology? 

Unannounced meal management technology could improve the performance of AID systems by enabling them to respond more effectively to glucose changes after meals. This automation would lessen the burden of glucose management, making it easier for people living with T1D to increase time in range with less effort.  

Diabeloop’s study is assessing this feature in teens, but eventually, the technology could be available to everyone with T1D. Although that study is taking place in Europe, there are many opportunities for people living with T1D in the U.S. to take part in research.  

 

You can participate in type 1 diabetes research from home — by joining the T1D Exchange Registry! It’s free, it only takes 15 minutes to get started, and you’ll have access to ongoing studies and surveys that help improve life for people with T1D.