When we talk about AID systems, a range of options spring to mind. Of the 5 commercial systems that are either here or nearly here, 3 of them run the control algorithm on the pump device and 2, like the DIY systems, run on either a phone or an additional device.
This might not seem like a very important thing to raise, and when there are people struggling to obtain or afford insulin, it’s probably not something most people are going to spend too much time worrying about. And yet. It can play a big part in how you get the best out of one of these devices.
For those who are active, and used to a pump, there is already the concern about what do you do with the pump when exercising. Obviously, if you use Omnipod, this is less of an issue.
But alongside that, using an AID system where the algorithm is separate from the pump puts you in an awkward position. If you don’t have the control device, you don’t have a hybrid closed loop.
Does this matter?
I think it’s something that people should perhaps consider when looking at the options for AID systems that they are presented with. For example, many DIY users that use AndroidAPS have two phones. One to run AAPS and their regular phone (especially if you’re generally an iPhone user). Do you want the overhead of that second device?
What about when you’re exercising? If you go for a run, where do you keep the device? Do you take your regular phone with you on your run? What if it’s a large (6″ screen) android device? Are you comfortable running with that?
I, for example, have stopped taking my Android phone with me when I run because it’s too large. That means my control algorithm sits at home and does nothing. It also means that I don’t have CGM. I could run it on a second phone, but that would mean carrying 3 phones around with me. It’s a first world, privileged problem to have, but then I could argue that of having an AID system and CGM available as well.
Or how about if you work in a place where phones aren’t able to be taken, whether that’s down to not allowing the people you work with access to them, or because of the risk that you might take and share photos?
Are you making a lot of fuss over nothing?
That’s also a good question. Once again, I think we’re into user preferences here. Having the option of using a separate control algorithm hopefully gives a user the option of multiple different available pumps, any one of which may suit them better than the one with the embedded algorithm.
I do, however, believe that the physical implementation of AID systems is likely to play as big a part in choice as anything else. And with this in mind, it’s understandable that there’s a significant amount of excitement about the Omnipod 5 system. It seems to offer the best of both worlds. Control Algorithm on the pump and bolus management from your phone. Even if Gary Scheiner has raised a few concerns over how the Omnipod 5 works.
However, you can’t bolus from a pod. While HCLs operate as they do, a bolusing phone app alongside a pump in your pocket with full control functions seems like the best way forward.
So what are you really saying?
This is yet another aspect of the differences between AID systems and what that means for the user. It highlights the issue that all the commercial systems have.
There is no way to try them and see which one works best for you.
Sure, if you have compatible kit, you might already know that a system with a phone controller is or isn’t for you from using a DIY system, but for the many that don’t, choosing which is best for you is going to come down to a paper comparison, and potentially expert guidance from healthcare professionals.
So it will remain an educated guess, and where control algorithms and physical systems come into play, that could prove to be an expensive mistake.