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A Multi-Parametric Islet Perifusion System within a Microfluidic Perifusion Device

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Refining Insulin on Board with netIOB for Automated Insulin Delivery.

Michael C Riddell¹, Dana M Lewis², Lauren V Turner¹

¹School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, ON, Canada.

Journal of Diabetes Science and Technology

|August 15, 2024

Summary

Automated insulin delivery (AID) systems improve glucose control, but the "insulin on board" (IOB) metric can be misleading. Current IOB displays don't accurately reflect real-time insulin action or dynamic adjustments in AID systems.

Keywords:

automated insulin delivery basal insulin bolus insulin continuous glucose monitoring continuous subcutaneous insulin infusion insulin on board multiple daily injections open-loop control type 1 diabetes

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Area of Science:

Endocrinology
Biomedical Engineering
Diabetes Technology

Background:

Automated insulin delivery (AID) systems significantly improve glycemic control in diabetes management.
A common feature in AID systems is the display of "insulin on board" (IOB) to prevent insulin stacking and inform dosing decisions.
Current IOB metrics aim to help users understand insulin action and predict hypoglycemia risk.

Purpose of the Study:

To examine the evolution of the "insulin on board" (IOB) metric in automated insulin delivery (AID) systems.
To highlight the limitations of current IOB presentations in accurately reflecting real-time insulin action and dynamic adjustments.
To discuss the implications of misleading IOB data for users of AID systems.

Main Methods:

This is a commentary, not an experimental study.
Analysis of the historical development and current implementation of IOB in AID systems.
Discussion of the physiological and technological factors influencing insulin action.

Main Results:

The presentation of IOB in current AID systems can be misleading.
Existing IOB metrics do not fully capture the dynamic and automatic insulin adjustments made by AID systems.
IOB does not accurately reflect true insulin action across varying physiological states.

Conclusions:

The current "insulin on board" metric in AID systems has significant limitations.
There is a need for improved IOB representations that better reflect real-time insulin dynamics and AID system adjustments.
More accurate IOB metrics are crucial for safe and effective use of AID systems and preventing glucose management errors.