THE MANAGEMENT of Type 2 diabetes, particularly in patients treated with insulin, presents ongoing challenges in achieving optimal glycaemic control. Research suggests that automated insulin delivery (AID) systems may play a significant role in enhancing glucose management. In a recent study, AID systems were compared with traditional insulin delivery methods in adults with insulin-treated Type 2 diabetes.
In the 13 week, multicentre randomised controlled trial, a total of 319 patients were randomly assigned, in a 2:1 ratio, to either the AID group or a control group (continuation of pretrial insulin delivery). Both groups used continuous glucose monitoring (CGM) throughout the study. The trial’s primary outcome was the reduction in glycated haemoglobin (HbA1c) levels, with secondary outcomes assessing CGM metrics. The findings demonstrated that AID systems were associated with superior glycaemic control compared to standard insulin delivery methods, providing valuable insights for clinical practice.
The authors observed significant improvements in the AID group compared to the control group. The mean HbA1c level in the AID group decreased by 0.9%, from 8.2%±1.4% at baseline to 7.3%±0.9% at week 13, while the control group saw a mean reduction of 0.3 percentage points, from 8.1%±1.2% at baseline to 7.7%±1.1% at week 13 (mean adjusted difference –0.6%; 95% CI: –0.8 ––0.4 (p<0.001). Furthermore, greater HbA1c reductions were observed for adults with a higher baseline HbA1c (9% or higher), as well as participants in the AID group using glucagon-like peptide-1 receptor agonists (GLP-1s), sodium-glucose transport protein 2 (SGLT2) inhibitors or both classes of medication at baseline. Additionally, time spent in the target glucose range (70–180 mg/dL) increased by 14% in the AID group (48% at baseline; 64% at week 13), compared to 1% (51% at baseline; 52% at week 13) in the control group.
In conclusion, the study demonstrates that AID systems are more effective than traditional insulin delivery methods in improving glycaemic control in insulin-treated Type 2 diabetes patients. These findings support the integration of AID systems into clinical practice, particularly for patients struggling with poor glycaemic control. However, the study’s limitations include its short duration and the fact that it primarily involved adults using insulin pumps or multiple daily injections. Further research should focus on a longer follow-up period to confirm the long-term benefits and safety of AID systems in a broader patient population.
Bertie Pearcey, EMJ
Reference
Kudva YC. Et al. A Randomized Trial of Automated Insulin Delivery in Type 2 Diabetes. N Eng J Med. 2025; DOI: 10.1056/NEJMoa2415948.
