Six-month real-world glycemic improvement after Smart MDI system in type 1 diabetes

Smart multiple daily injection (Smart MDI) system integrating continuous glucose monitoring (CGM), insulin pens, and decision-support tools may optimize glycemic control in type 1 diabetes (T1D). However, real-world data remain limited. We evaluated 6-month glycemic outcomes following transition to Smart MDI in adults with T1D and explored differences according to carbohydrate counting status.

This retrospective, single-center, observational study included 24 adults with T1D on MDI who transitioned to Smart MDI. CGM metrics were analyzed at baseline and after 1, 3, and 6 months. The primary outcome was change in time in range (TIR 70-180 mg/dL). Secondary outcomes included time above range (TAR), time below range (TBR), mean glucose, glucose management indicator (GMI), coefficient of variation, and HbA1c. Exploratory analyses compared individuals practicing carbohydrate counting (n = 12) with those who did not (n = 12).

TIR increased progressively from 56.1 ± 20.4% to 66.3 ± 17.5% (median change +9.0%, P < .01). TAR and TBR significantly decreased. HbA1c declined from 7.6 ± 1.1% to 7.3 ± 0.9% (median change -0.2%, P = .01). While between-group differences were not significant, individuals not practicing carbohydrate counting showed preliminary within-group improvements in TIR, TAR, mean glucose, GMI, and HbA1c, without increased TBR, whereas changes in the carbohydrate counting group were smaller.

Transition to the Smart MDI system was associated with clinically meaningful improvements in CGM metrics and HbA1c over 6 months. Improvements among individuals not practicing carbohydrate counting suggest that the Smart MDI system may provide standardized decision support also beneficial in less structured self-management settings. Larger studies are warranted to confirm these findings.