What’s the Difference Between Insulin Pumps and Automated Insulin Delivery (AID) Systems?

Automated insulin delivery (AID) systems are insulin pumps that can automatically adjust insulin delivery in response to a person’s glucose levels. They can lessen the guesswork and the micromanagement of diabetes. In short, AID systems can help to lighten the burden of Type 1 diabetes by improving time in range (set blood glucose level targets) while lowering disease burnout, diabetes distress, and other health issues.

Understanding how these systems work can help you choose an option that’s best for you. While this new generation of technology has created a lot of excitement and promise, it’s not a cure for diabetes. 

What are insulin pumps?

Standard insulin pumps are semiautomated, smart devices. They help people living with diabetes to keep blood glucose (sugar) levels within target range. Insulin is delivered through a tiny catheter that’s inserted into the skin and changed every 3 days. 

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A standard insulin pump has fixed rates of insulin delivery. This means it doesn’t communicate with a continuous glucose monitor (CGM) for automatic insulin adjustments. In other words, insulin pumps are hands-on systems.

An insulin pump gives rapid or short-acting insulin in two ways:

• Basal: This is a small, background dose of insulin that continuously infuses.

• Bolus: This is insulin you take for meals or to correct a rising or high level of blood glucose.

What is an automated insulin delivery system?

AID systems are designed to do the job of the pancreas. They’re mainly used by people living with Type 1 diabetes — an autoimmune condition in which the body destroys its insulin-producing cells.

An AID system has three parts: 

• A continuous glucose monitor (CGM)

• An insulin pump

• An algorithm (which acts as the brain of the system, connecting the CGM with the pump and automating the way they respond to each other)  

Together, this technology automatically adjusts insulin delivery. Over the years, AID systems have also been called an “artificial pancreas” or “bionic pump.”

How do AID systems work?

Here’s how AID systems match insulin delivery to a person’s glucose levels:

1. Identification: The CGM picks up changes in glucose levels.

2. Communication: Information about glucose levels is shared with an algorithm (in the insulin pump).

3. Action: Basal insulin delivery is adjusted, and/or a bolus is recommended or given automatically.

Regardless of the AID system you choose, it won't simplify every aspect of living with diabetes.

You’ll still need to give input to the pump at times. And you'll still need to fill, wear, charge, insert, and care for your equipment.

The amount of input you have to give your insulin pump or AID depends on whether your system is: 

• Open loop: fully user controlled

• Closed loop: fully hands off (automated)

• Hybrid: semiautomated with an occasional need for user input 

Let’s look at the differences and the options for each.

Open-loop systems

Open-looping is when a person uses a CGM and pump, without an algorithm to automate the insulin response to a changing glucose level. In other words, the system needs input from the user. 

All AID systems have the option to use open-loop mode so you can manually control insulin delivery when needed.

Hybrid closed-loop AID systems

Hybrid closed-looping systems have some hands-off (automated) actions but still need user input at times. These capabilities can vary among systems. 

For all hybrid systems, the CGM picks up on glucose changes and communicates these with the insulin pump. This may trigger some automatic insulin adjustments, to keep glucose levels within a preset range. 

But a hybrid closed-loop system only does part of the work that a healthy pancreas does. It doesn’t know how to adjust for meals or exercise. These adjustments need user input. That’s why it’s called a “hybrid” system.

The FDA has approved the following hybrid closed-looping systems:

• Medtronic MiniMed™ 780G insulin pump (age 7 and older) and Guardian™ 4 Sensor CGM

• Medtronic MiniMed™ 770G insulin pump, (age 2 and older) and Guardian™ 3 Sensor  CGM (ages 2 and older) 

• Tandem t:slim x2™ insulin pump with Control-IQ, Dexcom G7 CGM, or Abbott FreeStyle Libre 2 Plus CGM (age 6 and older) 

  • Tandem Mobi has received FDA clearance and is expected to be available in early 2024. It’s the smallest AID system to date, and it’s fully controllable with an iPhone.

• Omnipod® 5 and Dexcom G6 CGM is the first tubeless AID system. It’s approved for ages 2 and up.

There are also popular do-it-yourself (DIY) ways to create a hybrid-closed loop system, but these aren’t FDA approved.

Closed-looping AID systems

A closed-looping system technically does not need any user input for insulin dosing. The iLet Bionic Pancreas from Beta Bionics is the only FDA-approved closed-loop system (for ages 6 and older).

This is a mostly hands-off system. You only need to enter your weight and tell the pump when you’re eating (a small, medium, or large meal). The rest is “bionic.” 

What are the pros and cons of closed-looping and hybrid closed-loop systems?

Choosing an insulin delivery device is a personal preference. There are advantages and disadvantages. Consider them closely before deciding what’s best for you.

While these devices aren’t perfect, they can help to improve the quality of life for those living with Type 1 diabetes.

Advantages of both closed-looping and hybrid closed-loop systems

Here are some pros of closed-looping and hybrid closed-loop systems:

• Less disease burden and worry

• Increased quality of life

• More safety and time in range (fewer high and low blood glucose levels)

• Better sleep, with stable blood glucose levels overnight

• Health benefits with more time in range

Disadvantages of closed-looping and hybrid closed-loop systems

Here are some possible cons of closed-looping and hybrid closed-loop systems:

• Pump issues: like a kinked catheter, air in the tubing, disconnection, spoiled insulin, and absorption problems (like with traditional insulin pumps)

• CGM issues: such as bleeding, bent sensors, transmitter interferences, disconnection, inaccuracy, and warming-up periods

• Insulin limitations: slow to work, can spoil in heat, refills every 3 days

• Power limitations: power required to keep the system charged, need to replace the batteries and the transmitter

• User error: not updating settings for best results

• Expenses: initial equipment cost and maintenance

Do automated insulin delivery devices cost a lot?

Yes, but out-of-pocket costs vary. Cost depends on your insurance plan, copays, deductibles, and max out-of-pocket expenses. In general, most private insurance companies will cover some of the costs after approval.

According to research in 2015, the average cost of an insulin pump system (without insurance) was $6,000. Supplies were between $3,000 to $6,000 per year.

If you have Medicare, it’s important to understand what’s covered in your plan and what any out-of-pocket costs will be. Once approved, durable medical supplies such as a CGM and an insulin pump should have coverage. Plans usually cover some of the cost of an insulin pump. 

There’s also an ongoing cost of supplies (sensors, transmitters, tubing, and infusion sets).

While technology can help with diabetes self-care, many people have affordability or access issues. It’s a common challenge that people face — even with health insurance.

By contacting your insurance company, you can find out what your benefits will cover. Learn more about coverage and the appeals process with this health insurance guide from the JDRF (formerly known as the Juvenile Diabetes Research Foundation). The JDRF can help you appeal a decision if you are denied coverage. Between 40% to 50% of denials are successfully overturned when appealed.

How do you get started on an AID system?

If you’re curious about AID systems, it’s never too early to ask if an AID system may be a good fit for you. There are several steps in the approval process. Here’s how to start:

• Talk with your primary care provider or a diabetes care and education specialist about AID systems.

• Get approval from your primary care provider. It must be medically necessary for your insurance to cover it.

• Wait for insurance approval. If denied, appeal using the JDRF guide.

• Check the cost of monthly supplies. 

• Order the pump, CGM, and supplies.

Why is diabetes technology important?

If you live with diabetes, you probably have a lot on your mind. It can be difficult to balance everyday diabetes tasks, such as managing blood glucose levels, taking insulin, planning meals, and staying active. All that work can take a toll on your mental health. For example:

• Among people with diabetes, 1 in 4 will have symptoms of depression in their lifetime. 

• Adolescents with Type 1 diabetes have five times the depression rate as their peers.

AID systems help to simplify management and lighten the load of living with diabetes. AID system benefits include:

• Removing some daily tasks to lighten disease burden

• Making adjustments or suggestions based on real-time CGM glucose data

• Allowing for self-adjusting insulin delivery, which can improve time in range

• Lessening or suspending insulin to prevent hypoglycemia (low blood glucose)

• Increasing or bolusing insulin to prevent or treat hyperglycemia (high blood glucose)

• Improving hemoglobin A1C (HbA1C or A1C) with hands-off features

Why trust our experts?

Written by:

Jewels Doskicz, RN, BA

Jewels Doskicz, RN, BA, is an Arizona-based registered nurse with 22 years of hospital-wide clinical nursing experience and 11 years of medical writing and editing experience. She was a former healthcare content creator for a digital health tool at HealthLoop and director of clinical content operations at GetWellNetwork.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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