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Automated Insulin Delivery Use Among Preschool-Age Children With Type 1 Diabetes: A T1D Exchange Multicenter Analysis
Risa M Wolf1,2, Emma Ospelt3, Dhruvi Vora3
1Division of Pediatric Endocrinology, Johns Hopkins Medicine, Baltimore, MD, USA.
Journal of Diabetes Science and Technology
|June 23, 2026
Summary
Automated insulin delivery (AID) systems significantly improve glycemic control in preschool-age children with type 1 diabetes (T1D). Real-world data show AID use is linked to lower HbA1c levels and a higher chance of meeting ADA targets.
Area of Science:
- Pediatric Endocrinology
- Diabetes Technology
- Metabolic Diseases
Background:
- Limited real-world data exist on automated insulin delivery (AID) systems in preschool-age children with type 1 diabetes (T1D).
- This study addresses the gap by comparing glycemic outcomes in young children using AID versus multiple daily injections (MDIs).
Purpose of the Study:
- To assess real-world glycemic outcomes in preschool-age children (≤6 years) using AID systems.
- To compare these outcomes with those of children using multiple daily injections (MDIs).
Main Methods:
- Retrospective, multicenter, cross-sectional analysis of 3521 children (≤6 years) from the T1D Exchange Quality Improvement Collaborative (T1DX-QI).
- Glycemic outcomes, specifically HbA1c levels, were compared between AID users and MDI users.
- Multivariable regression models adjusted for key demographic and clinical factors.
Main Results:
- 48% of children used AID, with a mean HbA1c of 7.9%, compared to 52% using MDI with a mean HbA1c of 8.8% (P < .0001).
- AID use was associated with a nearly twofold increased odds of achieving an HbA1c <7% (OR 1.91).
- Overall, 25% of the cohort achieved an HbA1c <7%.
Conclusions:
- Real-world use of AID systems in preschool-age children with T1D is associated with improved glycemic control.
- AID systems demonstrate a greater potential for achieving the American Diabetes Association's recommended HbA1c target of <7% in this population.
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