When it comes to Automated Insulin Delivery (AID) systems, there is no single ‘best’ option, only the right one for each individual. With the help of my good friend and fellow diabetes tech wizard, Anne-Marie Frohock from Oxford, we have transformed the choice into selecting a Superhero. Each has strengths, weaknesses, and characteristics making them suited to different situations. As could be heard on The Fast Show, “Suits you, sir!“.
Do you prefer control and flexibility like Spider-Man?
Do you want a powerful, aggressive system like Hulk?
Do you need a highly adaptable, strategic system like Batman?
Or do you want a sleek, simple, and futuristic option like Iron Man?
Here, we compare the four leading AID systems: Tandem t:slim X2, Medtronic 780G, CamAPS FX, and Omnipod 5, through the lens of the superheroes they most resemble.
Tandem t:slim X2 with Control-IQ → Spider-Man
“With great power comes great responsibility.”
Why Spider-Man?
Just like Peter Parker, Control-IQ provides a great deal of power, but that power comes with responsibility. The system offers manual control over basal rates and correction factors (the most important driver of the algorithm), and allows different profiles, making it highly customisable to varying insulin sensitivity during the day and on different days. This is ideal for users who want fine-tuned insulin management.
However, this level of control requires maintenance. Settings must be frequently updated based on insulin needs, especially in children and adolescents, whose insulin sensitivity fluctuates more often.
Strengths:
- Highly customisable, allowing multiple insulin profiles
- Works well for those who prefer hands-on control
- Activity and Sleep modes to stay in target
Limitations
- Requires frequent basal rate and correction factor updates to ensure the algorithm does its job
- Less aggressive in correcting post-meal glucose spikes due to five-hour active insulin time and only increasing insulin when predicted to be above 8.9 mmol/L (160 mg/dL)
- Requires manual upload to Glooko to assess control, aka, you need a computer with a USB port
Best for: Adults or highly engaged caregivers or children/adolescents who want full control over insulin settings.
Medtronic 780G → The Incredible Hulk
“The strongest there is to crush after-meal highs!”
Why Hulk?
The Medtronic 780G is a powerful, aggressive system designed to smash through hyperglycaemia with strong autocorrection boluses. With active insulin time set as low as two hours, and glucose target at 5.5 mmol/L (110 mg/dL) it reacts faster than all other systems.
However, just like Hulk’s strength can be unpredictable, the 780G pushes insulin on board after meals, which can lead to lows for people with irregular activity levels. It works best when routines are stable.
Strengths
- The most aggressive system for tackling high glucose levels
- Highly automated, requiring minimal user intervention
- Strong overnight glucose control
Limitations
- Can overcorrect, leading to unexpected lows with sporadic activity levels
- Requires Medtronic’s CGM (Guardian 4 or Simplera), which lacks iCGM certification and underreports high glucose levels when compared to the Dexcom G7 and Freestyle Libre 3. Maybe the high time in range (3.9-10.0 mmol/L or 70-180mg/dL) reported from the 780G will not translate into as low an HbA1c and future complications risk as you may expect? As the IFCC Working Group for CGM (me being one of them) would say, this is one of the many reasons why we need standardisation of CGM accuracy testing, via an ISO Standard, as soon as possible!
- Cannot customise the glucose target across the day to account for variability in insulin sensitivity
Best for: Those who want high automation and strong post-meal glucose control, particularly people with stable routines.
CamAPS FX → Batman
“With planning and preparation, I can beat anyone.”
Why Batman?
Batman relies on preparation and strategy, just like CamAPS FX. This system offers highly customisable glucose target settings (4.4-11.0 mmol/L or 80-200 mg/dL, for up to 48-time blocks!) and sophisticated algorithm updates, making it the most adaptable system available. It also has a Boost mode when insulin insensitive, Ease-off for times of sensitivity, Add Meal options for hypo carbs and slowly absorbed meals (high-fat).
However, much like Batman relies on his gadgets, CamAPS FX runs from a smartphone and requires users to engage with the extra functionality. The user must carry their phone at all times, or the system won’t function, and must interact often, to get the most out of it.
Strengths
- The most adaptable system, allowing multiple glucose targets throughout the day, and announcement of hypo’s and high-fat meals
- Well suited for people needing tight control, such as pregnancy
- The most well-researched system across all age groups, with the most sophisticated algorithm that adapts continuously
Limitations
- Requires an Android phone (not iPhone-compatible as of March 2025)
- Requires a good understanding of when and how to use the different bells and whistles
- Needs phone connectivity at all times, so the phone must stay close
Best for: Those who want the highest level of customisation, particularly pregnant users, athletes, or those with fluctuating insulin needs.
Omnipod 5 → Iron Man
“Call me the billionaire playboy!”
Why Iron Man?
Omnipod 5 is sleek, wireless, and compact, much like Iron Man’s high-tech suits. The SmartAdjust™ algorithm alters insulin delivery every five minutes by micro-bolus, and the algorithm is housed in the Pod, so the phone or controller is not needed for the magic to happen. The Adaptive Basal Rate that drives SmartAdjust™ updates automatically based on the total daily insulin doses from the last 4-5 Pods, eliminating the need for user intervention.
However, like Tony Stark’s tech, it comes at a cost, both financially and in terms of glucose targets. Omnipod 5 lowest target is 6.1 mmol/L (120 mg/dL), which may not be ideal for those wanting ultra-tight control.
Strengths
- Tubeless design makes it discreet and easy to wear
- Highly automated, requiring little user input, and super simple to set up and operate
- The algorithm is housed in the Pod allowing seamless automated adjustments.
Limitations
- Higher glucose targets compared to most other systems
- More expensive than some other AID options, especially when combined with premium CGM sensors (Dexcom G7 in the UK)
- Limited customisation compared to Control-IQ and CamAPS FX
Best for: Those who want a simple, effective, tubeless system with minimal maintenance.
Putting it all together
| AID System | Superhero | Best Feature | Limitations | Best For |
|---|
| Tandem t:slim X2 with Control-IQ | Spider-Man | Customisable and flexible control | High maintenance, requires regular updates | Adults & engaged users |
| Medtronic 780G | Hulk | Most aggressive post-meal correction | It can lead to high insulin on board after meals, limited customisation | Those with stable routines |
| CamAPS FX | Batman | Most flexible targets & features | Requires Android phone, learning curve | Pregnant users, athletes, insulin-sensitive individuals |
| Omnipod 5 | Iron Man | Sleek, tubeless, easy to use | Higher glucose targets, expensive | Kids, beginners, those wanting an easy life, tubeless seekers |
Final Thoughts
Each AID system brings something different to the table, just like our superheroes. Whether you need control (Spider-Man), power (Hulk), strategic planning (Batman), or sleek automation (Iron Man), there’s an AID system that fits your lifestyle.
At the end of the day, the right AID system is the one that works best for you, so choose your hero wisely!
They are all fantastic choices, but selecting the one most aligned to your needs might just put the cherry on top!
I hope this was a bit of fun!
Do you want a more comprehensive guide?
Thought so, check the AID System Guide
Also, check out the Six-Part Podcast Series on AID Systems
Cheers
John