Effect of daily insulin delivery variability on glycemic outcomes in patients with type 1 diabetes mellitus using an automated insulin delivery system

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-09-09 DOI:10.1016/j.diabres.2025.112476

Giuseppe Papa , Rossella Cannarella , Carmelo Gusmano , Concetta Finocchiaro , Massimiliano Anzaldi , Gianfranco Gruttadauria , Luca Patti , Donatella Lo Presti , Salvatore Scirè Calabrisotto , Rosita A. Condorelli , Sandro La Vignera , Aldo E. Calogero

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引用次数: 0

Abstract

Background

Automated insulin delivery (AID) systems are central to managing type 1 diabetes mellitus (T1DM), using continuous glucose monitoring (CGM) to adjust basal insulin (BI). Certain systems, such as the MiniMed™ 780G, also provide automated correction boluses (AB), while manual boluses (MB) are administered in response to carbohydrate intake. Despite the adaptive nature of these technologies, the influence of variability in individual insulin delivery components on glycemic outcomes remains insufficiently characterized.

Methods

This retrospective study analyzed 7,710 patient-days from 257 T1DM patients (236 adults, 21 pediatric) using the MiniMed™ 780G system for over six months. Variability in BI, AB, and MB—measured as BI-V%, AB-V%, and MB-V%—was assessed over 30-day periods and correlated with glycemic metrics including time in range (TIR_70-180), time above/below range (TAR, TBR), glucose coefficient of variation (CV), and glucose management index (GMI). Multivariate and ROC analyses were conducted.

Results

Mean TIR_70-180 exceeded 70 % in both groups. AB-V% (36.9 %) was significantly higher than BI-V% (16.8 %) and MB-V% (19.1 %). MB-V% was negatively associated with TIR and positively with TAR, while AB-V% showed the opposite. AB-V% >32.3 % and MB-V% ≤18.2 % predicted achieving TIR > 70 %.

Conclusion

Variability in insulin delivery, especially AB and MB, affects glycemic control in T1DM. Monitoring and optimizing these components may improve AID system effectiveness.

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使用自动胰岛素输送系统的1型糖尿病患者每日胰岛素输送变异性对血糖结局的影响

背景：自动化胰岛素输送（AID）系统是管理1型糖尿病（T1DM）的核心，使用连续血糖监测（CGM）来调整基础胰岛素（BI）。某些系统，如MiniMed™780G，还提供自动校正剂量（AB），而手动剂量（MB）则根据碳水化合物摄入量进行管理。尽管这些技术具有适应性，但个体胰岛素递送成分的可变性对血糖结局的影响仍未得到充分表征。方法：这项回顾性研究分析了257名T1DM患者（236名成人，21名儿科）使用MiniMed™780G系统超过6个月的7710个患者日。BI、AB和mb的变异性（以BI- v %、AB- v %和MB-V%测量）在30天内进行评估，并与血糖指标相关，包括在范围内的时间（TIR70-180）、在范围内的时间（TAR、TBR）、葡萄糖变异系数（CV）和葡萄糖管理指数（GMI）。进行多变量分析和ROC分析。结果：两组患者TIR70-180平均值均超过70 %。AB-V%（36.9 %）显著高于BI-V%（16.8 %）和MB-V%（19.1 %）。MB-V%与TIR呈负相关，与TAR呈正相关，而AB-V%则相反。AB-V% >32.3 %和MB-V%≤18.2 %预测TIR > 70 %。结论：胰岛素递送的变异性，尤其是AB和MB，影响T1DM患者的血糖控制。监测和优化这些组成部分可以提高艾滋病系统的有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.