APhA2026: Pharmacists Have a Critical Role to Play as Automated Insulin Delivery Moves Into Type 2 Diabetes

The clinical case for expanding automated insulin delivery (AID) and continuous glucose monitoring (CGM) to patients with type 2 diabetes (T2D) has never been stronger. Increasingly, pharmacists are called on to help drive that expansion through counseling, dispensing support, device education, and collaborative care.

At the 2026 American Pharmacists Association Annual Meeting and Exposition in Los Angeles, California, Katelyn O'Brien, PharmD, BCPS, CDCES, BC-ADM, clinical pharmacist at Boston Medical Center in Massachusetts, and Casey Wells, PharmD, BCACP, CDCES, CPP, internal medicine and endocrinology clinical pharmacist at Mountain Area Health Education Center in Asheville, North Carolina, walked attendees through the evidence for AID in T2D and outlined practical strategies pharmacists can use immediately.

The session arrived at a pivotal moment in the field. The 2026 American Diabetes Association Standards of Care in Diabetes now recommend AID systems as the preferred insulin delivery method for adults with T2D on multiple daily injections (MDIs), continuous subcutaneous insulin infusion, or sensor-augmented pump therapy. They also state that AID systems should be considered for patients on basal insulin alone who are not meeting individualized glycemic goals. The guidelines also removed prior authorization barriers, specifying that no C-peptide level, islet autoantibody test, or minimum insulin duration should be required before initiating AID.¹

The Unmet Need in T2D

Wells opened by grounding the conversation in a stark reality: most insulin-requiring patients with T2D are not meeting glycemic targets. A retrospective cohort analysis has found that over 80% of patients with T2D on MDIs fail to achieve a hemoglobin A_1C (HbA_1C) below 7%, and nearly 60% have HbA_1C values above 8%. When left unchecked, that degree of hyperglycemia carries serious consequences. A nested case-control study found a 16% increased risk of major cardiovascular events with higher blood glucose levels, and a microsimulation model estimated that reducing HbA_1C from above 9% to below 8% could translate to approximately 3.5 additional years of life expectancy.²

"I like to think about the patient—specifically those who aren't meeting that goal," Wells told attendees. "Is it that they're scared of needles? Is it that they forget their insulin at home? Or is it my largest bucket of patients, who are just struggling with the diabetes math—a different dose for every meal, a sliding scale, adding everything up?"²

AID systems, she argued, can directly address each of those barriers. Wells highlighted several categories of patients who have often been dismissed as poor candidates for insulin pump therapy but who, in her experience, stand to benefit most: patients who fear injections, patients who are inconsistent with dosing due to the complexity of MDI regimens, and high-insulin users who have previously been told a pump would not be appropriate. The clinical evidence supports expanding candidacy well beyond traditional assumptions.²

The Evidence Base: A Diverse, Clinically Representative Population

Wells reviewed data from the SECURE-T2D trial (NCT05815342), a prospective, open-label, single-arm pivotal study of 305 participants across 21 US institutions evaluating AID use in patients with T2D. The trial enrolled a population that Wells described as highly representative of the patients she sees in clinic: 46% Hispanic, Latino, or Black; lower income; 84% not carbohydrate counting at baseline; more than half on concomitant glucagon-like peptide-1 receptor agonist therapy; and approximately half with HbA_1C above 8% at enrollment. It is the most racially diverse pivotal study in T2D diabetes device research to date, which Wells said significantly increases the external validity of the findings for pharmacists and clinicians working in safety-net and community health settings.^2,3

The results were meaningful across the board. Mean HbA_1C declined from approximately 8.2% to 7.4%, and patients with the highest baseline HbA_1C (>9%) saw a 2.1% reduction. Time in range (70-180 mg/dL) improved by a mean of 20% compared with standard of care, without a corresponding increase in hypoglycemia. Daily insulin use also decreased by approximately 29%, a finding Wells emphasized is expected when patients transition from MDIs to AID, as the more frequent, precisely calibrated microdosing enabled by AID systems is better absorbed than large subcutaneous bolus injections. Patient satisfaction was also high, with 90% of trial participants saying they would recommend the device to a family member or friend.^2,3

Wells shared one of her own patient examples: a woman with HbA_1C of 9.7% who, within 4 weeks of initiating AID therapy—before any manual settings changes—dropped to 7.6% and achieved 65% time in range. "The algorithm removed one of those barriers that was preventing her from getting to goal," she explained.²

Real-world evidence from postmarket data reinforces the trial findings. Even patients who rarely interact with the bolus calculator—those Wells described as using "simplified carbs," entering 5 or fewer meal entries per day—maintained clinically meaningful time in range, with no increase in hypoglycemia compared to patients actively carbohydrate counting. This has important implications for pharmacists and clinical teams, as it suggests patients do not need to achieve carbohydrate-counting proficiency before benefiting from AID therapy.²

CGM as a Foundation: What the Evidence Shows

O'Brien shifted the conversation toward the mechanics of the AID algorithm and the practical fundamentals pharmacists need to understand when dispensing, counseling, or supporting patients on these systems. At the core of any AID system, she explained, are real-time CGM data. The sensor reads interstitial glucose every 5 minutes, and the algorithm uses that reading, along with a trend arrow and a 1-hour predictive model, to automatically adjust insulin delivery in the background, increasing delivery when glucose is trending high and reducing or pausing it to protect against lows.²

This real-time glucose feedback is also the reason CGM itself has become a cornerstone of diabetes care independent of AID. An umbrella review of 31 systematic reviews found that CGM use in patients with T2D was associated with significant reductions in HbA_1C compared with self-monitoring or usual care, with consistent improvements in time in range and time above range.⁴

Pharmacist-led CGM workflows have also demonstrated meaningful outcomes: A 2025 study published in the Journal of the American College of Clinical Pharmacy found that a pharmacist-led diabetes management and education clinic using personal CGMs significantly improved glycemic outcomes in T2D patients across a large academic health system. A separate pilot study at Northwestern Medicine found that integrating CGM into primary care using a multidisciplinary team, including a clinical pharmacist and certified diabetes care and education specialist, was both feasible and effective in patients with T2D who had not previously had CGM access or endocrinology involvement.^5,6

"I can tell them as a pharmacist how to carb count if I had something; I can read a nutrition label," O'Brien told attendees, humanizing the carbohydrate-awareness conversation. "But I can't look at a meal at a restaurant and say that's 100 carbs. I don't know that. And I think that helps normalize things for my patients."²

She emphasized that simplified meal entry options and the use of emoji-based food icons in the device interface can make AID accessible for patients with lower health literacy, cognitive challenges, or limited English proficiency—groups that are often systematically excluded from technology-based diabetes management.²

What Pharmacists Can Do Right Now

Both speakers identified pharmacists as a critical point of intervention in the AID onboarding pipeline. O'Brien noted that prescribing errors, such as ordering incompatible pod kits for a patient's CGM sensor, are common and that pharmacists are positioned to catch these errors before they delay a patient's therapy initiation. She also noted that confirming whether an intro kit has been included in a new prescription, ensuring the correct number of pods per month based on a patient's insulin requirements, and verifying that a compatible rapid-acting insulin vial has been prescribed are all high-yield actions a pharmacist can take.²

Wells added that pharmacists in dispensing settings should feel empowered to have the AID conversation with any insulin-requiring T2D patient who is not meeting glycemic goals, not just those already identified by a physician for device therapy.^2,7

"I've had a patient's primary care provider say, 'That's only for people with type 1 diabetes,'" she said, recounting a case of a 37-year-old patient with T2D who had an HbA_1C of 10.4% and time in range of just 17%. After initiating AID therapy, that patient's time in range rose to 67% within 3 weeks and 81% by 3 months, without any manual settings adjustments. The 2026 ADA Standards of Care make clear that the evidence no longer supports that type-based restriction.²

"People who have lower cognitive function, who are not carb-aware, who struggle with the diabetes math—these are not reasons to avoid AID therapy," Wells said. "These are exactly the reasons to recommend it."²

REFERENCES

1. American Diabetes Association Professional Practice Committee for Diabetes. Diagnosis and classification of diabetes: standards of care in Diabetes—2026. Diabetes Care. 2026;49(suppl 1):S27-S49. doi:10.2337/dc26-S002

2. O'Brien K, Wells C. Presentation theater #3: Omnipod 5 for type 2 diabetes: advancing insulin therapy through simplicity. Presented at: American Pharmacists Association Annual Meeting & Exposition; March 28, 2026; Los Angeles, CA.

3. Pasquel FJ, Davis GM, Huffman D, et al; Omnipod 5 SECURE-T2D Consortium. Automated insulin delivery in adults with type 2 diabetes: a nonrandomized clinical trial. JAMA Netw Open. 2025;8(2):e2459348. doi:10.1001/jamanetworkopen.2024.59348

4. Gallagher A. Continuous glucose monitoring shows potential to improving clinical outcomes in type 2 diabetes. Pharmacy Times. January 3, 2025. Accessed March 30, 2026. https://www.pharmacytimes.com/view/continuous-glucose-monitoring-shows-potential-to-improving-clinical-outcomes-in-type-2-diabetes

5. Pasour T, Sheehan L, Troyer M, Conger M, Carson P. Evaluation of a pharmacist-led personal continuous glucose monitor workflow to improve glycemic management in an internal medicine clinic. J Am Pharm Assoc (2003). 2024;64(4):102139. doi:10.1016/j.japh.2024.102139

6. Zadel AH, Chiampas K, Maktaz K, et al. Continuous glucose monitoring in primary care: multidisciplinary pilot implementation study. JMIR Diabetes. 2025;10:e69061. doi:10.2196/69061

7. Lilly A, King CA, Ortiz J. Primary care providers' and staff confidence and awareness of continuous glucose monitors following pharmacist-led education and training: a pre-post cohort study. J Am Coll Clin Pharm. 2025;8(9):884-894. doi:10.1002/jac5.70090