Insulin Tech Limit

1. **Brief critique and context**: The conjecture posits that closed-loop insulin delivery systems, even with continuous glucose monitoring (CGM), are insufficient to achieve a mean HbA1c below 6% without additional behavioral interventions. This is a significant claim as it challenges the current trajectory of diabetes management technology, which increasingly emphasizes the role of automation in achieving tighter glucose control. The inherent complexity and variability of human physiology and behavior, alongside the current capabilities of technology, provide a basis for this conjecture. However, technological advancements are rapidly evolving, potentially challenging this assertion.

2. **Recent research**: Recent studies have demonstrated significant improvements in glycemic control using closed-loop systems. For instance, the study by Tauschmann et al. (2018) showed that closed-loop systems reduced HbA1c levels in type 1 diabetes patients, but not consistently below 6% without additional support (https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30121-2/fulltext). More recent developments, such as the use of advanced algorithms and machine learning, suggest potential for further improvement (https://care.diabetesjournals.org/content/early/2021/06/03/dc21-0503).

3. **Bayesian likelihood of falsification (with reasoning)**: 30%. Given the current trajectory of technological advancements in closed-loop systems and the integration of new algorithms, there is a moderate likelihood that the conjecture might be falsified within five years. However, achieving an HbA1c below 6% remains challenging primarily due to the variability in patient adherence, physiological differences, and the current technical limitations of these systems. The necessity for adjunctive behavioral interventions still holds significant weight in consistently achieving such low HbA1c levels.