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Automated Insulin Delivery Systems: Impact on Clinical Practice, Discontinuation, Rejection, and Reasons for Not
Timm Roos1,2, Norbert Hermanns1,2,3, Lutz Heinemann3
1Research Institute of the Diabetes-Academy Bad Mergentheim (FIDAM), Bad Mergentheim, Germany.
Journal of Diabetes Science and Technology
|May 7, 2026
Summary
Automated insulin delivery (AID) systems show high satisfaction but face challenges. Addressing usability and trust issues is key to increasing adoption for people with type 1 and type 2 diabetes.
Area of Science:
- Endocrinology
- Diabetes Technology
- Health Services Research
Background:
- Automated insulin delivery (AID) systems improve glycemic control in type 1 diabetes but their clinical uptake and user experiences are understudied.
- Limited research exists on AID for type 2 diabetes and cross-country comparisons.
Purpose of the Study:
- To investigate the uptake, perspectives, and experiences of healthcare professionals (HCPs) and people with diabetes (PWD) regarding AID systems.
- To compare AID relevance, indications, barriers, and satisfaction across Germany, Austria, Switzerland, and Spain.
Main Methods:
- A multinational online survey (dt-report 2025) of 1294 HCPs and 2535 PWD across Germany, Austria, Switzerland, and Spain.
- Assessment of AID relevance, indications, barriers, daily use, satisfaction, and support needs.
Main Results:
- Fully closed-loop systems are seen as the most promising future therapy by HCPs.
- 90% of people with type 1 diabetes (PWT1D) and 55% of people with type 2 diabetes (PWT2D) on intensified insulin therapy are considered AID candidates.
- 22% of eligible PWD rejected AID due to device burden and usability concerns; 8% discontinuation rate reported by HCPs. High satisfaction reported, but technical issues, trust, and expectations impact outcomes.
Conclusions:
- Despite increasing use, many users report management difficulties or discontinuation of AID systems.
- Addressing usability, trust, and expectations can improve AID adoption and patient outcomes.
- HCPs hold a positive view on AID use in people with type 2 diabetes.
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