Real-World Safety and Effectiveness of U200 Insulin Use in Automated Insulin Delivery Systems in Adolescents and Young Adults with Type 1 Diabetes.

Limited insulin pump cartridge volumes can present challenges to automated insulin delivery (AID) system use for adolescents and young adults (AYA) with type 1 diabetes (T1D) and high insulin requirements. We assessed the real-world safety and effectiveness of U200 concentrated insulin use in AID (U200-AID) among AYAs with T1D. We conducted a two-center, retrospective cohort study assessing glycemia, pump utilization, and safety outcomes pre-/post-U200-AID. Among 50 AYAs initiating U200-AID (age 15.4 years, T1D duration 5.5 years, hemoglobin A1c 8.5%), time in range (70-180 mg/dL) increased (44.6% ± 12.6% vs. 48.9% ± 11.4%, P = 0.012) and time below range (<70 mg/dL) did not change significantly. Days between cartridge changes increased (2.2 ± 0.5 vs. 3.0 ± 0.5 days, P < 0.001) despite increased total daily insulin dose (102.6 ± 23.5 vs. 125.8 ± 38.9 U100 insulin units, P < 0.001). No severe hypoglycemia or diabetic ketoacidosis occurred (median follow-up 290 days [interquartile range 227, 476]). These data suggest that U200-AID is a viable option for individuals with T1D and high insulin requirements.