Securing Automated Insulin Delivery Systems: A Review of Security Threats and Protectives Strategies

2025-03-18

AI Summary

Automated insulin delivery (AID) systems face severe cybersecurity threats due to their reliance on wireless communication and software-based control, potentially leading to life-threatening therapeutic errors. This paper conducts a systematic literature review integrating threat modeling, attack surface analysis, regulatory compliance mapping, and cross-platform security assessment to establish, for the first time, a holistic AID security framework spanning technical, legal, and industrial dimensions. Key contributions include: (1) a comprehensive security challenge map covering vulnerabilities, attack vectors, defense mechanisms, and evaluation methodologies; and (2) two novel research directions—standardized security evaluation frameworks and lightweight adaptive defense strategies. The framework provides a reusable paradigm for secure design and verification of digital diabetes therapeutics and other physiological closed-loop medical devices.

Technology Category

• Application Domains: Security
• Philosophy and Ethics of AI: Privacy & Security
• Humans and AI: Planning and Decision Support for Human-Machine Teams

Application Category

• Security and Privacy: Large-scale security measurements
• Systems and Infrastructure for Web, Mobile and WoT: Web applications in cross-disciplinary domains and verticals such as mixed reality, smart cities, and digital health
• User Modeling, Personalization and Recommendation: Attacks and countermeasures in recommendation systems

Abstract

Automated insulin delivery (AID) systems have emerged as a significant technological advancement in diabetes care. These systems integrate a continuous glucose monitor, an insulin pump, and control algorithms to automate insulin delivery, reducing the burden of self-management and offering enhanced glucose control. However, the increasing reliance on wireless connectivity and software control has exposed AID systems to critical security risks that could result in life-threatening treatment errors. This review first presents a comprehensive examination of the security landscape, covering technical vulnerabilities, legal frameworks, and commercial product considerations, and an analysis of existing research on attack vectors, defence mechanisms, as well as evaluation methods and resources for AID systems. Despite recent advancements, several open challenges remain in achieving secure AID systems, particularly in standardising security evaluation frameworks and developing comprehensive, lightweight, and adaptive defence strategies. As one of the most widely adopted and extensively studied physiologic closed-loop control systems, this review serves as a valuable reference for understanding security challenges and solutions applicable to analogous medical systems.

Problem

• Identifies security risks in automated insulin delivery systems.
• Reviews vulnerabilities, attack vectors, and defense mechanisms for AID systems.
• Highlights challenges in standardizing security frameworks for medical systems.

Innovation

• Integrates glucose monitor, insulin pump, algorithms
• Analyzes security vulnerabilities, attack vectors, defenses
• Proposes lightweight, adaptive defense strategies