The amount of information on AIDS is overwhelming. I know, it’s taken me four years to get my head round it. Trying to fathom which one to choose is a challenge.
I have condensed four years of learning to provide you with the most important questions to guide your decision:
- What AIDS are available to you?
- Which CGM device do you prefer?
- How much control do you want of the algorithm?
- How aggressive do you want to algorithm to be in preventing after meal spikes?
There is no best system, only the best system for you.
So, work through these questions and see which one jumps out at you!
Which CGM device do you prefer?
If you are already using CGM you will have a bias to what you like. So, use your own experience and go with what you like.
Full disclosure, I have tried ALL the sensors and done my own vigorous accuracy checks testing them head-to-head. Every time the Dexcom G6 wins for me, so that’s why I use it!
I also wrote a scientific paper assessing the accuracies of all sensors and again the Dexcom G6 came out on top.
The Dexcom G6 and Libre 2 are the only sensors to have been granted FDA iCGM approval. As a recap for you. To attain iCGM status the accuracy of the sensor must reach a very high bar, tested on a wide age range of people with type 1 diabetes!
The Enlite 3 used with the 670G does not reach that bar. The Enlite 4 used with 780G is more accurate, however, to date, the accuracy papers have not been published and they have not been granted iCGM status yet. The Enlite 4 might get iCGM status in the future, but as of April 2022, it has not.
The above table shows the Medtronic devices only work with the Enlite sensors and the other systems work with the Dexcom G6. I am sure in the future commercially available AIDS will work with the Libre sensors. The DIY options allow you to use almost any sensor, but again, they are unregulated and are challenging to set up.
How much control do you want of the algorithm?
This is a very important question, so take some time to think.
Do you want the system to do 90% of the heavy lifting by constantly updating the settings?
If yes, then the best choices are the Medtronic 670G, Medtronic 780G and CamAPS FX.
All you must do is enter your weight, your carb ratios and choose what target glucose level you want the algorithm to aim for!
You only need to keep your carb ratios up to date and the algorithm takes care of the rest. This means you are not reliant on yourself or your diabetes team to correctly update settings such as basal rates and correction factors.
Basically, these systems reduce user error and minimise diabetes hassle.
However, if you are a person who has different sensitivities to insulin on different days, this can cause some problems.
For example, if you are not very active during the week but extremely active on the weekend, it’s likely the algorithm will be too strong on the weekend.
Another example, if you are on medications that spike your glucose levels that you take sporadically, such as steroids, the algorithm will struggle be able to keep up with the medication. There are some limited settings to help with this on these systems.
Finally, if you are a person who likes to tinker, you will not be able to do this.
Alternatively, do you want control of how the algorithm works and the flexibility to adapt as necessary?
If yes, the best choices are T-Slimx2 with Control IQ or a DIY option.
All these systems require the user to set and regularly update the basal rates, correction factors and carb ratios.
For adults, this usually means working hard for the first month but only infrequent adjustments to fine tune.
For children this means grafting first month and regular updates every three months or so.
The success of these systems is quite reliant on the user and the diabetes team who support.
This does not sound very attractive; however, these systems offer flexibility.
For example, you can have a different profile of settings for weekdays and weekends and even holidays.
Also, you can make settings much more aggressive for times of illness or medications.
Reading this I am sure you will know if your want more or less hassle and more or less flexibility.
Final question.
How aggressive do you want to algorithm to be in preventing after meal spikes?
The major limitation of all AIDS is that they use “Fast Acting” insulin. This is misleading because the “Fast-Acting” insulins are not as fast as the carbohydrate absorption form meals.
This means that glucose spikes after eating high carbohydrate meals still happen.
Of course, you want to do the basics of eating balanced meals, carb counting accurately and giving insulin 10-20minutes before eating.
However, we all know this is not possible 100% of the time.
How effective AIDS are at tackling after meal glucose spikes depends on two things:
- The “Target level” the algorithm aims for
- The aggressiveness of the algorithm
This table shows the different target levels that can be set on the AIDS. Very simply, the lower the target can be set, the quicker the algorithm will start increasing the insulin.
From most to least aggressive:
- DIY
- CamsAPS FX
- 780G
- T-Slimx2 with Control-IQ
- 670G
The second and more important consideration is how you can adjust the algorithm settings to make it more aggressive.
It all comes down to can you adjust active insulin time and carbs on board time.
Active insulin time is the time the algorithm thinks the insulin lasts for. When insulin is given for food or corrections, the algorithm uses active insulin time to calculate how much insulin on board there is that might drop the glucose level. This is then used in the calculations of how much extra insulin to give to tackle highs. The shorter you set it, the more aggressive the algorithm will be.
Carbs on board time (if recognised by the system) is the time the algorithm thinks the carbs form the meal get digested over. If the system recognises carbs on board it is used to deduct from the insulin on board when calculating how much extra insulin for highs.
It is a little complicated as all AIDS work differently. This table gives a high-level overview.
From most to least aggressive:
- DIY (if active insulin set 3 hrs and correct carb absorption time set)
- 780G (if active insulin set 2 or 2 ½ hrs)
- 670G (if active insulin set 2 or 2 ½ hrs)
- CamsAPS FX
- T-Slimx2 with Control-IQ
There is a trade-off to consider.
The more aggressive the algorithm is set, the less highs but potential increased risk of lows.
There we have it.
First, find out what’s available.
Second, think about what CGM sensor you want to use.
Third, consider how much hassle and flexibility you want from the algorithm
Finally, ponder how aggressive you would like the system to be from after meal spikes.
Great, your have made your choice.
It’s time to select the tips, tricks and management page for the your system