This article documents a small, proof-of-concept trial showing the feasibility, safety and efficacy of use of closed loop insulin pump therapy in disabled adults with insulin-requiring type 2 diabetes who require home health care assistance.

Although the study included a small sample size (n = 30), it was well designed and implemented and clearly demonstrated that disabled adults with type 2 diabetes who require intensive insulin therapy can benefit with improved time in range by CGM, lowering of HbA1c and improved patient and caregiver satisfaction using closed loop insulin delivery via the Tandem T-slim insulin pump compared to use of an MDI regimen.

This benefit was achieved using fixed insulin boluses via pump, indicating that carbohydrate counting was not essential for successful use of closed loop insulin delivery in this population.

The limitations of the study include small sample size (acknowledged as such by the authors), relatively short duration of the study, and the fact that the study protocol was fairly labor-intensive (requiring two 3 day hospitalizations to learn use of the AID system as well as fairly intensive ongoing support from healthcare providers, both in the home and remotely).

Nevertheless the benefits of using the AID system appear to outweigh these limitations.

This study sets the groundwork for further study of use of AID systems managed by caregivers with appropriate support from HCP's in patients on intensive insulin therapy who are either physically or technologically challenged and who are frequently denied use of AID systems.

Congratulations to the authors for demonstrating this proof-of concept in a well-designed trial!

Revisions noted; acceptable for publication!