Performance of an Automated Insulin Delivery System in People Living With Type 2 Diabetes and Insulin Resistance: First Real-World Evidence in 26 427 Users.

Background: Type 2 diabetes (T2D) is a phenotypically heterogeneous disease. The use of insulin is required in a significant portion of people with T2D, despite recent developments in antidiabetic medications. This study analyzes glycemic outcomes in automated insulin delivery (AID) users with T2D with different insulin requirements.

Methods: This is a retrospective, real-world analysis including MiniMed 780G (MM780G) data uploaded to CareLink Personal (January 2020 to April 2024). Four cohorts were identified based on phenotypes of T2D: (A) users with total daily dose of insulin (TDD) ≥ 100 IU, (B) users with self-reported T2D, (C) users with self-reported T2D and TDD ≥ 100 IU, and (D) users with self-reported T2D and TDD <100 IU. Glycemic outcomes and insulin use were assessed post-AID, pre-AID versus post-AID, and six-month longitudinal post-AID.

Results: A total of 26 427 users were included in this study, of which 18 466 in cohort A, 10 795 in cohort B, 2 834 in cohort C, and 7 961 in cohort D. Mean time in range (TIR) was 71.1% ± 12.2 for cohort A, 75.1% ±14.1 for cohort B, 72.2% ± 15.0 for cohort C, and 76.1% ± 13.6 for cohort D. Mean time below range (TBR) <70 mg/dL was ≤1% in all cohorts. The users in cohort C using the recommended optimal settings (glucose target [GT] of 100 mg/dL and active insulin time [AIT] of two hours) had a greater TIR with 78.7% ± 10.8. All cohorts increased ≥10% post-AID compared with pre-AID.

Conclusions: The use of this AID is associated with effective therapy outcomes, as indicated by over 70% TIR, and appears to be safe, as demonstrated by a low TBR in a large cohort of real-life users with self-reported T2D and high or low TDD.