Is MDI Under Attack?
AID stands for Automated Insulin Delivery - a smart insulin pump that connects to a continuous glucose monitor (CGM). Some people who are insulin dependent love the idea of an algorithm doing the thinking about insulin dosing. While some of us with type 1 diabetes are very much turned off by it. The cons include safety risks and high costs among other responsibilities to consider that make AID systems not worth transitioning to.
The American Diabetes Association guides the Standards of Care - written to give healthcare providers direction about treating diabetes - and they make some very bold statements about AID. To read one document full of “shoulds” click HERE. Other tidbits of information state that AID are now considered a “primary insulin delivery choice” surpassing multiple daily injections (MDI).
From my perspective, these statements include debatable language that makes me wonder if the ADA forgot they were created to serve ALL people with diabetes. There is a massive flood of research on AID systems with one Google and it makes me wonder, who’s working for who to influence the choices of people who don’t make any insulin at all or are insulin resistant to the point that insulin is prescribed?
When people with diabetes, especially type 1 diabetes, feel like they’re being told what to do versus being informed, our demeanor tends to shift. We can tell when industry is involved in recommendations - it’s not our first trip around the sun, if you know what I mean. In the diabetes community we already deal with so much industry influence related to diet, supplements, and what we “should” be doing.
With consideration to the clients I’ve worked with in the last year - several of whom were hounded by insulin pump reps when they didn’t ask for it - pushing AID is another way to avoid talking about root problems that are embedded in a person’s relationship with food, stress, exercise, and other lifestyle factors for prevention.
The following is a post I wrote on LinkedIn that generated a lot of support for MDI -
“As a representative of multiple daily injections (MDI) I'd like to make something clear: just because I choose not to use an insulin pump doesn't mean that I'm struggling to meet A1C or time in range goals. Nor does it mean that any of us on MDI are anti-tech. In fact, a lot of us prefer MDI because it gives us more freedom to be active and it's often WAY more affordable.
Fact: if AID doesn't have significant increased health benefits over MDI, we're gonna keep kickin' it old school with injections. Feel free to inform us of our options, but please don't underestimate our management style.
Obviously, I use tech in my own way and I love comparing my heart rate to CGM trends while I'm teaching cycling classes. Betchya never thought of that, huh?
If you work with people with diabetes please be mindful of the ADA stating that "AID systems 'should' be the preferred insulin delivery method to improve glycemic outcomes". Respectfully, I don't want the ADA "shoulding" on my choice to manage diabetes with MDI + lifestyle.
Maybe the key opportunity isn't always to add more tech, maybe it's to open up a dialogue with PWD about creating a lifestyle strategy that works for them. And that strategy is supported by technology if they so choose.
Despite what the powers that be think people who are insulin dependent "should" do, it remains equally as important how diabetes care professionals communicate, motivate, and provide options.
Many of my clients would say that technology + lifestyle is a perfect partnership, and how they maintain blood glucose goals isn't because of technology alone - it's their lifestyle choices that continuously drive positive outcomes and gives them power over diabetes.”