Table 2.

Limitations of AID systems

Physiological

1. Time lag in sensor glucose values as measured in ISF vs blood

2. Delayed absorption of insulin from subcutaneous depot; pharmacodynamic effects of applied insulin are different from physiological secreted insulin

Technological

1. Suboptimal analytical accuracy of CGM systems in low glucose range

2. Compression of tissue around sensor insertion site leads to falsely detected hypoglycaemia

3. Missing sensor glucose data (e.g., due to transmission failures) and sensor warm-up time

4. Glucose sensor overreading and inadvertent overdelivery of insulin

5. Infusion set failures or pod failure

6. Outright pump failure due to software or hardware issues

7. Issues with data uploading, regular exchange of batteries, loss of communication between components of the AID system/cloud network

8. Server interruptions leading to inability to remotely track data

9. Cybersecurity/data protection/data privacy

10. Need for regular update of software/operating systems/apps

11. Impact of work or environmental conditions has to be considered (i.e., exposure to high or low temperatures, magnetic fields, or water)

Behavioural

1. Patient needs to bolus prandial insulin

2. Requirement of correction boluses

3. Problem-solving for hyperglycaemia (i.e., detect failed infusion sets, broken system components)

4. Avoidance of hyperglycaemia overcorrections and avoiding adding fake carbs, etc.

5. Overtreatment of hypoglycaemia

6. Limitations and challenges of exercise

7. Need for backup supplies