Implementing Automated Insulin Delivery in Type 2 Diabetes, With Diana Isaacs, PharmD

Despite relatively limited uptake, recent research has shown the efficacy of automated insulin delivery (AID) systems in patients with type 2 diabetes (T2D).1

At the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026 in Las Vegas, Nevada, Diana Isaacs, PharmD, director of education and training in diabetes technology at Cleveland Clinic, presented a statement on the benefits of implementing AID devices in T2D care – and the importance of knowing the full breadth of options available for a given patient.

“With T2D, we have 3 algorithms that have been approved; however, we actually have 5 algorithms total, and we have 6 different insulin pumps that can be options,” Isaacs told HCPLive in an exclusive interview. “There are definitely a lot of choices, and I believe that we as healthcare professionals shouldn’t necessarily choose for the person. But it is up to us to know what’s out there, so we can present the different options.”

Clinical guidelines have lately begun including AID devices among treatment recommendations for patients; recently, the American Diabetes Association released the 2026 Standards of Care in Diabetes, which included a series of revisions to the prior document. Among these was a statement that AID systems are the preferred delivery system for both adult and child patients with T2D on multiple daily injections or sensor-augmented pump therapy. Additionally, the new guidelines recommend the consideration of AID systems in patients with T2D on basal insulin who fail to meet individualized glycemic goals.2

Additionally, in a recent 13-week multicenter trial, investigators determined that adults with T2D treated with AID saw a greater reduction in glycated hemoglobin levels than via continuous glucose monitoring (CGM) alone. The study enrolled 319 patients, randomly assigned in a 2:1 ratio to receive either AID or to continue their pretrial insulin delivery method. Both groups received CGM throughout the trial.3

Ultimately, glycated hemoglobin dropped by 0.9 percentage points (from 8.2+/-1.4% at baseline to 7.3+/-0.9% at week 13) in the AID group and by 0.3 percentage points (from 8.1+/-1.2% to 7.7+/-1.1%) in the control group (mean adjusted difference, -0.6 percentage points; 95% CI, -0.8 to -0.4; P <.001). The mean time in range for patients also increased in the AID group and control group, respectively. All other multiplicity-controlled outcomes measured substantially better in the AID group as well. The trial ultimately displayed the efficacy of AID devices in T2D, underscoring the revised treatment guidelines.3

Isaacs also discussed the interplay between AID pumps and more prominent T2D treatments, such as GLP-1 RAs and SGLT2 inhibitors. Given their substantial and well-established efficacy, Isaacs notes that these medications are in no way being superseded by insulin – rather, clinicians should manage these treatments in tandem.

“In T2D, we want to optimize GLP-1 agonists and SGLT2 inhibitors,” Isaacs said. “When you look at the guidelines, GLP-1 drugs should be offered and used before insulin is even started. These drugs are essential, and we’re not suggesting that pumps would ever replace them. The beautiful thing about these pumps is that they’re constantly adjusting insulin, so they’re very good at being able to back off the insulin as needed as these drugs are added.”

Editors’ Note: Isaacs reports disclosures with Abbott, Sanofi, Insulet, Mannkind, Lilly, Novo Nordisk, and others.

References

1. Aleppo G, Isaacs D. Insulin Pumps for Type 2 Diabetes. Presented at the American Association of Clinical Endocrinology Annual Meeting 2026, Las Vegas, NV. April 22-24, 2026.

2. American Diabetes Association Professional Practice Committee for Diabetes*. Summary of Revisions: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(1 Suppl 1):S6-S12. doi:10.2337/dc26-SREV

3. Kudva YC, Raghinaru D, Lum JW, et al. A randomized trial of automated insulin delivery in type 2 diabetes. New England Journal of Medicine. 2025;392(18):1801-1812. doi:10.1056/nejmoa2415948