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Postprandial Glycemic Control With Automated Insulin Delivery With Control-IQ Technology: The Impact of Meal
Marco Marigliano1, Claudia Piona1, Elisa Morotti1
1Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy.
Diabetes, Obesity & Metabolism
|July 20, 2026
Summary
Automated insulin delivery (AID) systems with Control-IQ struggle to manage blood sugar after high-fat or high-protein meals in adolescents with type 1 diabetes. New strategies are needed for better glycemic control with complex meals.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Pediatric Diabetes Management
Background:
- Adolescents with type 1 diabetes (T1D) often face challenges in postprandial glucose control.
- Automated insulin delivery (AID) systems aim to improve glycemic management in T1D.
- The efficacy of AID systems with Control-IQ technology in managing diverse macronutrient meals requires further evaluation.
Purpose of the Study:
- To assess the effectiveness of an AID system (Tandem Tslim X2 with Control-IQ) using carbohydrate counting (CHC)-based premeal boluses for postprandial glucose (PPG) control.
- To compare PPG control after standard, high-fat (HF), and high-protein (HP) meals in adolescents with T1D.
- To determine if the AID system autonomously adjusts insulin delivery in response to varying meal compositions.
Main Methods:
- A prospective crossover study involving 25 adolescents with T1D.
- Participants consumed three iso-caloric meals (745 kcal): standard, HF (45.9% fat), and HP (24.4% protein).
- A CHC-based bolus was administered 15 minutes pre-meal, with continuous glucose monitoring and AID data collected over 6 hours.
Main Results:
- Six-hour time in range (TIR) was significantly lower after HF (65.2%) and HP (49.9%) meals compared to standard meals (84.3%).
- Postprandial glucose exposure (AUC) was significantly higher after HF and HP meals at both 3 and 6 hours.
- The AID system increased insulin delivery for HF (+26%) and HP (+55%) meals without inducing hypoglycemia.
Conclusions:
- Standard CHC-based premeal boluses with AID systems (Control-IQ) are insufficient for adequate PPG control after HF and HP meals in adolescents with T1D.
- Significant autonomous insulin increases by the AID system did not fully compensate for macronutrient variations.
- Proactive, meal-specific insulin dosing strategies are necessary to optimize glycemic outcomes following nutritionally complex meals.
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