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Long-Term Glycemic Outcomes in Pediatric Type 1 Diabetes: A 2-Year Real-World Analysis of Different Automated Insulin

Tim Lührs1, Olga Kordonouri1, Thekla von dem Berge1

  • 1Diabetes Center, Children's Hospital AUF DER BULT, Hannover, Germany.

Diabetes Technology & Therapeutics
|September 15, 2025
PubMed

Insights

Automated insulin delivery (AID) systems improve glycemic control in children with type 1 diabetes, with noncalibration systems showing better long-term results. Initial benefits may decrease after the first year, requiring sustained management strategies.

Area of Science:

  • Pediatric Endocrinology
  • Diabetes Technology
  • Metabolic Disorders

Background:

  • Type 1 diabetes management in children and adolescents often involves complex insulin regimens.
  • Transitioning to automated insulin delivery (AID) systems aims to improve glycemic control and reduce the burden of diabetes management.
  • Evaluating the long-term effectiveness of different AID systems is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To assess long-term glycemic control changes in children and adolescents with type 1 diabetes after switching to various AID systems.
  • To compare the performance of calibration-requiring (Medtronic MiniMed™ 670G) versus noncalibration (Medtronic MiniMed™ 780G, Tandem Control-IQ) AID systems.
  • To identify factors influencing glycemic control outcomes in this population over a 24-month period.

Main Methods:

  • A monocentric retrospective study analyzed real-world data from 305 children and adolescents with type 1 diabetes (CwD) transitioning to AID.
  • Data from 12 to 24 months post-transition were evaluated, comparing HbA1c, time in range (TIR), mean glucose, and other glycemic metrics.
  • Nonparametric tests and multiple linear regression were used to assess between-system differences and predictive factors for HbA1c.

Main Results:

  • All AID systems significantly improved TIR, mean glucose, and glycemia risk index (GRI), and reduced time above and below range.
  • Hemoglobin A1c (HbA1c) decreased in the first year but returned towards baseline by the second year.
  • Noncalibration systems demonstrated superior outcomes at 24 months, including lower HbA1c (7.4% vs. 7.8%), reduced insulin dose, and increased automated mode time compared to the 670G system.

Conclusions:

  • Automated insulin delivery (AID) systems enhance glycemic control and reduce hypoglycemia in pediatric patients with type 1 diabetes.
  • Noncalibration AID systems offer better long-term performance compared to calibration-requiring systems.
  • Sustaining the initial glycemic benefits of AID beyond the first year necessitates further research into long-term management strategies.
Abstract

Keywords:
automated insulin deliveryhybrid closed looppediatricreal-world evidencetype 1 diabetes

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