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TABLE 2

Programmable Settings in the Omnipod 5 AID System

Parameter NameAvailable SettingsDescriptionImplications for Automated Mode
Basal Program Up to 24 segments per basal program, from 0 units/hour to user-set maximum basal rate in 0.05-unit/hour increments In manual mode, the Pod will deliver basal insulin at the programmed rates. The Basal Program is only used once when initiating therapy to estimate a user’s TDI and determine an adaptive basal rate for AID.
After the first Pod change, the algorithm uses actual TDI and updates TDI with each Pod change thereafter. The pre-programmed basal program is then irrelevant except in manual mode and has no further effect on automated delivery of insulin. 
Target Glucose Maximum of 8 segments per day from 110 to 150 mg/dL in 10-mg/dL increments The Target Glucose is the glucose value the algorithm aims for when calculating insulin delivery and the value the bolus calculator aims for when calculating correction bolus doses. Target Glucose is the primary parameter that affects automation. Insulin delivery will generally increase if glucose is predicted to rise above the target and decrease or suspend if glucose is predicted to fall below the target. If glucose is trending downward, insulin delivery may be decreased or suspended, even if the current glucose value is above target. If glucose is trending upward, insulin delivery may be increased, even if the current glucose value is below target. 
Activity Can be set for a duration of 1–24 hours The Activity feature temporarily reduces AID. It may be used to reduce the amount of insulin delivered with exercise or in other situations in which hypoglycemia risk may be increased. While Activity is enabled, the algorithm targets a glucose level of 150 mg/dL (instead of the programmed Target Glucose) and additionally reduces insulin delivery. To reduce insulin on board with exercise, it is best to turn on this feature 1–2 hours before the start of exercise. Keeping it activated for up to 12 hours after exercise may be useful if delayed hypoglycemia is a concern. 
Duration of Insulin Action (DIA) A single setting is programmed from 2–6 hours in 30-minute increments This setting informs the pump how long a bolus is actively working to reduce glucose. It is used to calculate the IOB remaining from past meal and correction boluses. The DIA programmed by users is only used to calculate IOB accrual from user-delivered boluses. This setting does not influence how IOB is calculated from AID; the algorithm uses its own method to determine IOB accrual from AID. When the algorithm increases insulin delivery in response to hyperglycemia, this insulin will factor into IOB and be subtracted from user-initiated boluses, in addition to the IOB from user-given boluses. As a result, correction boluses may be smaller than expected due to the additional IOB being taken into account from AID. 
Correction Factor Up to 8 segments per day of 1–400 mg/dL in 1-mg/dL increments This setting informs the pump of the user’s ICF—by how many mg/dL glucose is expected to drop from the delivery of 1 unit of insulin. It is used by the system’s bolus calculator in calculating correction boluses. The programmed ICF does not influence AID; it is only used for user-initiated correction boluses. This setting may need to be modified to improve the efficacy of user-initiated correction boluses when using the automated mode. 
Insulin to Carb (IC) Ratio Up to 8 segments per day of 1–150 g carbohydrate/unit of insulin in 0.1-g increments This setting informs the bolus calculator of the user’s ICR—how many grams of carbohydrate are covered by 1 unit of insulin. It is used by the bolus calculator to calculate mealtime boluses. A user’s ICR may need to be changed to optimize postprandial glucose control. Because the system reduces and/or suspends insulin delivery if glucose is trending down or below target, there is often little to no IOB leading up to mealtimes. With little IOB before meals, users may benefit from a stronger ICR when using an AID system compared with an MDI regimen or conventional pump therapy, in which static basal insulin infusion occurs regardless of glucose level, resulting in more pre-meal IOB. 
 Correct Above Up to 8 segments per day from target glucose level to 200 mg/dL in 1-mg/dL increments This setting is the glucose level at which the bolus calculator may calculate a correction dose. This value has no influence on AID. It may be adjusted to affect user-given correction boluses. 
Minimum Glucose for Calc 50–70 mg/dL in 1-mg/dL increments This setting defines a minimum glucose value at which the pump will allow use of the bolus calculator. This setting has no influence on AID. It may be adjusted to ensure a safe glucose value when delivering a bolus. 
Reverse Correction On or off When reverse correction is turned on, the bolus calculator will reduce the mealtime bolus amount when the current glucose value is below the target glucose. When in automated mode, users may consider turning reverse correction off if glucose is often below their target at mealtime and they are experiencing post-meal hyperglycemia. Turning the reverse correction off will ensure that users receive their full bolus dose for carbohydrates. 
Extended Bolus On or off Turning on this parameter will allow users to extend a bolus delivery over 0.5–8 hours when the pump is in manual mode. Extended boluses are not available in automated mode even if the parameter is turned on in the pump settings. Extended boluses can only be given in manual mode. 
Temp Basal On or off When turned on, this feature will allow users to program a temporary basal rate of delivery or to increase or decrease the programmed basal delivery by a percentage (0–100%) when in manual mode. Temporary basal rates are not available in automated mode, even if this feature is turned on in the pump settings. Temporary basal rates can only be used in manual mode. 
Maximum Bolus 0.05–30 units This setting defines the upper limit for a bolus dose. The pump will not deliver more than the maximum bolus amount programmed by a user. The Maximum Bolus setting has no influence on AID. It is only relevant for user-delivered bolus doses. 
Maximum Basal Rate 0.05–30 units/hour This setting defines the maximum basal rate the pump will allow in manual mode. Usually this is set to twice the highest user-programmed basal rate to allow for temporary basal rate increases as needed in manual mode. The programmed Maximum Basal Rate has no impact on AID. The algorithm determines maximum delivery for each user when in automated mode. 
Parameter NameAvailable SettingsDescriptionImplications for Automated Mode
Basal Program Up to 24 segments per basal program, from 0 units/hour to user-set maximum basal rate in 0.05-unit/hour increments In manual mode, the Pod will deliver basal insulin at the programmed rates. The Basal Program is only used once when initiating therapy to estimate a user’s TDI and determine an adaptive basal rate for AID.
After the first Pod change, the algorithm uses actual TDI and updates TDI with each Pod change thereafter. The pre-programmed basal program is then irrelevant except in manual mode and has no further effect on automated delivery of insulin. 
Target Glucose Maximum of 8 segments per day from 110 to 150 mg/dL in 10-mg/dL increments The Target Glucose is the glucose value the algorithm aims for when calculating insulin delivery and the value the bolus calculator aims for when calculating correction bolus doses. Target Glucose is the primary parameter that affects automation. Insulin delivery will generally increase if glucose is predicted to rise above the target and decrease or suspend if glucose is predicted to fall below the target. If glucose is trending downward, insulin delivery may be decreased or suspended, even if the current glucose value is above target. If glucose is trending upward, insulin delivery may be increased, even if the current glucose value is below target. 
Activity Can be set for a duration of 1–24 hours The Activity feature temporarily reduces AID. It may be used to reduce the amount of insulin delivered with exercise or in other situations in which hypoglycemia risk may be increased. While Activity is enabled, the algorithm targets a glucose level of 150 mg/dL (instead of the programmed Target Glucose) and additionally reduces insulin delivery. To reduce insulin on board with exercise, it is best to turn on this feature 1–2 hours before the start of exercise. Keeping it activated for up to 12 hours after exercise may be useful if delayed hypoglycemia is a concern. 
Duration of Insulin Action (DIA) A single setting is programmed from 2–6 hours in 30-minute increments This setting informs the pump how long a bolus is actively working to reduce glucose. It is used to calculate the IOB remaining from past meal and correction boluses. The DIA programmed by users is only used to calculate IOB accrual from user-delivered boluses. This setting does not influence how IOB is calculated from AID; the algorithm uses its own method to determine IOB accrual from AID. When the algorithm increases insulin delivery in response to hyperglycemia, this insulin will factor into IOB and be subtracted from user-initiated boluses, in addition to the IOB from user-given boluses. As a result, correction boluses may be smaller than expected due to the additional IOB being taken into account from AID. 
Correction Factor Up to 8 segments per day of 1–400 mg/dL in 1-mg/dL increments This setting informs the pump of the user’s ICF—by how many mg/dL glucose is expected to drop from the delivery of 1 unit of insulin. It is used by the system’s bolus calculator in calculating correction boluses. The programmed ICF does not influence AID; it is only used for user-initiated correction boluses. This setting may need to be modified to improve the efficacy of user-initiated correction boluses when using the automated mode. 
Insulin to Carb (IC) Ratio Up to 8 segments per day of 1–150 g carbohydrate/unit of insulin in 0.1-g increments This setting informs the bolus calculator of the user’s ICR—how many grams of carbohydrate are covered by 1 unit of insulin. It is used by the bolus calculator to calculate mealtime boluses. A user’s ICR may need to be changed to optimize postprandial glucose control. Because the system reduces and/or suspends insulin delivery if glucose is trending down or below target, there is often little to no IOB leading up to mealtimes. With little IOB before meals, users may benefit from a stronger ICR when using an AID system compared with an MDI regimen or conventional pump therapy, in which static basal insulin infusion occurs regardless of glucose level, resulting in more pre-meal IOB. 
 Correct Above Up to 8 segments per day from target glucose level to 200 mg/dL in 1-mg/dL increments This setting is the glucose level at which the bolus calculator may calculate a correction dose. This value has no influence on AID. It may be adjusted to affect user-given correction boluses. 
Minimum Glucose for Calc 50–70 mg/dL in 1-mg/dL increments This setting defines a minimum glucose value at which the pump will allow use of the bolus calculator. This setting has no influence on AID. It may be adjusted to ensure a safe glucose value when delivering a bolus. 
Reverse Correction On or off When reverse correction is turned on, the bolus calculator will reduce the mealtime bolus amount when the current glucose value is below the target glucose. When in automated mode, users may consider turning reverse correction off if glucose is often below their target at mealtime and they are experiencing post-meal hyperglycemia. Turning the reverse correction off will ensure that users receive their full bolus dose for carbohydrates. 
Extended Bolus On or off Turning on this parameter will allow users to extend a bolus delivery over 0.5–8 hours when the pump is in manual mode. Extended boluses are not available in automated mode even if the parameter is turned on in the pump settings. Extended boluses can only be given in manual mode. 
Temp Basal On or off When turned on, this feature will allow users to program a temporary basal rate of delivery or to increase or decrease the programmed basal delivery by a percentage (0–100%) when in manual mode. Temporary basal rates are not available in automated mode, even if this feature is turned on in the pump settings. Temporary basal rates can only be used in manual mode. 
Maximum Bolus 0.05–30 units This setting defines the upper limit for a bolus dose. The pump will not deliver more than the maximum bolus amount programmed by a user. The Maximum Bolus setting has no influence on AID. It is only relevant for user-delivered bolus doses. 
Maximum Basal Rate 0.05–30 units/hour This setting defines the maximum basal rate the pump will allow in manual mode. Usually this is set to twice the highest user-programmed basal rate to allow for temporary basal rate increases as needed in manual mode. The programmed Maximum Basal Rate has no impact on AID. The algorithm determines maximum delivery for each user when in automated mode. 
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