Adjusting the insulin dose between meals · Ceded (since 2016)

On 28 September 2016 the FDA approved the Medtronic MiniMed 670G, the first hybrid closed loop system, which reads glucose every five minutes and sets the basal insulin rate without asking anyone.

This is a prescribing decision, taken every five minutes, inside the body of the person who used to take it. A six month randomised trial published in the New England Journal of Medicine in 2019 found time in the target glucose range rising from 61 to 71 percent under closed loop control against 59 percent under manual management, about two and a half more hours a day in range. The loop is hybrid on purpose: the patient still announces meals and approves correction doses, the physician still writes the prescription and sets the limits, and during illness or pump failure the person takes the decision back. Within those limits the dose between meals has genuinely left human hands, and it is one of the few medical acts that a machine now performs on a patient at home, every day, unsupervised.