The evolution of automated insulin delivery (AID) systems in individuals with Type 1 Diabetes (T1D) is entering a new phase. Having progressed from a pump with continuous glucose monitoring (CGM) to hybrid closed-loop (HCL) systems, the field is now moving towards fully closed-loop (FCL) control, where glucose regulation is achieved without user intervention. In March 2026, at the Advanced Technologies & Treatments for Diabetes (ATTD) Congress, CamDiab announced CamAPS Liberty, a fully closed-loop feature integrated into its widely deployed CamAPS® FX platform, marking a significant step towards commercially available autonomous insulin delivery1.
Hybrid Closed Loop: a cognitive burden remains
HCL systems comprise a continuous glucose monitoring device (CGM), an insulin pump, and an algorithm that automatically adjusts insulin delivery based on blood glucose readings, while meal boluses remain managed by the user.
Although HCL systems reduce the relentless day-to-day decisions of self-care, they remain intrinsically dependent on user input: users are required to estimate carbohydrate intake, manually deliver pre-meal boluses, and announce other snacks, meals and hypoglycaemia treatments.
The CamAPS® HCL algorithm is an adaptive, self-learning control algorithm which uses Model Predictive Control (MPC) to optimize insulin delivery. The algorithm predicts future blood glucose levels based on the current state (from CGM data), active insulin, planned boluses (via user meal announcement), and carbohydrate intake (via user input), body weight (user entered) and total daily insulin dose. The algorithm automatically estimates additional parameters, such as insulin sensitivity and insulin action time, and continuously updates them to reflect daily variations in blood glucose, insulin requirements, and individual responses2.
Since the HCL algorithm relies on user input, user adherence affects algorithmic performance. HCL systems are largely reactive: without meal announcements, the system responds only once glucose levels begin to rise. This limitation is compounded by physiological delays in interstitial glucose sensing and insulin absorption, requiring conservative dosing strategies to mitigate hypoglycaemia risk. A consequence of this is that if a user does not announce a meal, a spike in glucose levels will occur after the meal, with the HCL system taking some time to bring the glucose level back within target range.
Fully closed loop: autonomy with constraints
FCL systems aim to eliminate user input, by replacing user carbohydrate counting and pre-meal bolusing with real‑time predictive control.
Without meal announcements, the FCL algorithm must infer meals from CGM signals, for example by detecting rapid glucose rate-of-change. The predictive control algorithm must also control glucose excursions without knowledge of the size of the meal eaten, whilst operating safely to avoid hyper-/hypo- glycaemic events.
FCL systems have been shown to improve glycaemic control compared with a pump with CGM in Adolescents with T1D and HbA1c above target3. Furthermore, FCL systems (AIDANET) have been shown to improve glycaemic control compared to existing HCL systems, primarily overnight4. These (small-scale) studies suggest that FCL systems may offer an important therapy option in at least some groups, but potentially across a broader population.
Despite this, for those engaging well with the HCL system (i.e. performing accurate carbohydrate counting and proactively bolusing pre-meal), an HCL system will still provide tighter postprandial control than a FCL system, resulting in a higher time in range5. The overall objective therapeutic benefit is therefore, at present, limited to those not capable of / willing to engage fully with the HCL system
CamAPS Liberty will represent the first commercially available FCL system for type 1 diabetes. When activated, the system removes the need for carbohydrate counting or pre-meal bolusing, instead relying on a more proactive version of the CamAPS® control algorithm designed to anticipate and respond to glucose fluctuations within defined safety limits.
Given the tighter control offered to those that engage well with the HCL system, Liberty is not positioned as a wholesale replacement for HCL. Rather, it introduces a selectively deployable mode. The feature is explicitly designed “to complement, not replace” existing diabetes management strategies, offering users the option to reduce cognitive and emotional burden during periods of increased stress or demand.
This dual-mode architecture highlights a current trade-off in AID design. HCL remains the optimisation mode: user-announced meals enable tighter postprandial control and more precise insulin timing. In contrast, FCL prioritises autonomy and reduced cognitive load at the cost of some loss in glycaemic optimisation.
Real-world deployment
The integration of FCL functionality into an established commercial platform is likely to generate substantial real-world evidence, enabling large-scale direct comparison between HCL and FCL performance under routine conditions, providing insight into usage patterns, clinical outcomes, and user behaviour.
Since Liberty uses a more proactive version of the existing HCL algorithm, we might see improved glycaemic control, across the general population, for Liberty versus the existing HCL system under certain conditions, such as overnight (if the more proactive version of the algorithm remains overnight). If such a pattern were to emerge, a user could toggle (or the platform could be configured to switch) between the HCL system for the periods where the HCL performs optimally (e.g. around meals) and the FCL system where the FCL system performs optimally (e.g. possibly at night) providing the optimisations seen in both systems.
Regardless of whether such “general population” patterns emerge, the option for a switch to FCL might offer improved glycaemic control in certain patient groups where the HCL system is not currently providing optimal control, because users struggle with adhering to the cognitively demanding requirements for optimal use of an HCL system.
A dense and evolving patent landscape
This shift towards autonomous control is mirrored in an increasingly dense patent landscape. The diabetes device space - particularly CGM systems, insulin pumps, and control algorithms - is already heavily protected, with growing emphasis on machine learning, glucose prediction, and adaptive dosing frameworks.
In Europe, mathematical methods are excluded from patentability unless they contribute to the “technical character” of an invention. In practice, this requires that claimed algorithms produce a technical effect, for example by controlling a physical system or improving the processing of physiological data.
For closed-loop systems, this necessitates grounding claims in specific technical implementations, such as feedback control using CGM data, model-based glucose prediction, adaptive insulin delivery, and safety-constrained dosing strategies.
For FCL systems, applications might concentrate on aspects such as new ways of identifying unannounced meals from CGM data, the features of an algorithm which enable tighter postprandial control, or operational mode switching within a system.
Summary
FCL systems promise a shift from assisted to autonomous care. The question is not whether autonomy is achievable, but how it will be optimised, adopted, and protected.
[1] https://camdiab.com/press-releases/liberty-260310
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC12678213/
Susannah is a UK and European patent attorney working in the engineering and technology team. Her practice covers a wide range of technical subject matter, with a particular focus on medical devices, surgical instruments, medical imaging systems, surgical data processing systems, software, and user interfaces. She has considerable experience in successfully attacking and defending granted European patents during opposition and appeal proceedings, with a particular focus on medical devices/systems. She is experienced in proactive management of large, complex patent portfolios and the successful adaptation and prosecution of US-originating invention applications before the EPO, as well as providing validity and infringement opinions of granted UK patents, coordinating multinational patent families, and prosecuting applications in patent offices around the world.
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