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arXiv · 2503.14006

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

Yuchen Niu·Siew-Kei Lam
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Abstract

Automated Insulin Delivery (AID) systems represent a significant advancement in diabetes care and wearable physiological closed-loop control technologies, integrating continuous glucose monitoring, control algorithms, and insulin pumps to improve blood glucose level control and reduce the burden of patient self-management. However, their increasing dependence on wireless communication and automatic control introduces security risks that may compromise patient privacy or result in life-threatening treatment errors. This paper presents a comprehensive survey of the AID system security landscape, covering technical vulnerabilities, regulatory frameworks, and commercial security measures. In addition, we conduct a systematic review of attack vectors and defence mechanisms proposed in the literature, following the PRISMA framework. Our findings highlight critical gaps, including the lack of specific security evaluation frameworks, insufficient protections in real-world deployments, and the need for comprehensive, lightweight, and adaptive defence mechanisms. We further investigate available research resources and outline open research challenges and future directions to guide the development of more secure and reliable AID systems. By focusing on AID systems, this review offers a representative case study for examining and improving the cybersecurity of safety-critical medical wearable systems.

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Yuchen Niu, Siew-Kei Lam. 2025-03-18. Securing Automated Insulin Delivery Systems: A Review of Security Threats and Protective Strategies. https://doi.org/10.1016/j.cose.2025.104733

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