Automated insulin delivery improves glycemic control of type 2 diabetes in randomized trial

Jaeb Center for Health Research conducted a randomized controlled trial evaluating the impact of automated insulin delivery (AID) in adults with insulin-treated type 2 diabetes. AID significantly lowered glycated hemoglobin (HbA1c) levels and improved glucose control compared to standard insulin therapy with continuous glucose monitoring (CGM).

AID therapy resulted in a mean HbA1c reduction of 0.9 percentage points over 13 weeks, while the control group experienced a 0.3 percentage point reduction.

Automated insulin delivery systems have demonstrated benefits for patients with type 1 diabetes, yet their efficacy and safety for individuals with type 2 diabetes remain less established. Prior studies have either lacked randomized controlled designs or involved limited sample sizes, creating a gap in clinical understanding.

While medications such as glucagon-like peptide 1 (GLP-1) receptor agonists and sodium–glucose cotransporter 2 (SGLT2) inhibitors help some individuals achieve glucose targets, a substantial number of insulin-treated patients continue to struggle with glycemic control.

In the study, “A Randomized Trial of Automated Insulin Delivery in Type 2 Diabetes,” published in The New England Journal of Medicine, researchers conducted a multicenter randomized controlled trial to assess the efficacy and safety of AID in adults using multiple daily insulin injections or insulin pumps.

A total of 319 patients across 21 centers in the United States and Canada participated. Patients were randomly assigned in a 2:1 ratio to either the AID group, which received the t:slim X2 insulin pump with Control-IQ+ technology and a Dexcom G6 sensor, or the control group, which continued their pretrial insulin regimen while using real-time unblinded CGM.

Baseline HbA1c levels averaged 8.2% (±1.4) in the AID group and 8.1% (±1.2) in the control group. Over 13 weeks, HbA1c decreased to 7.3% (±0.9) in the AID group and 7.7% (±1.1) in the control group. A difference of –0.6 percentage points was observed between the groups.

CGM data indicated an increase in time spent within the target glucose range (70–180 mg/dL) from 48% (±24) to 64% (±16) in the AID group and from 51% (±21) to 52% (±21) in the control group. An adjusted difference of 14 percentage points was recorded, equating to 3.4 additional hours per day spent in the target glucose range with AID.

Additional CGM-based measures of hyperglycemia showed significant improvement in the AID group. Mean glucose levels decreased by 21 mg/dL. Time spent with glucose levels above 250 mg/dL decreased by 9.1 percentage points.

Low levels of CGM-measured hypoglycemia were observed in both groups. One severe hypoglycemia event was reported in the AID group, with no occurrences in the control group. No cases of diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome were recorded.

Some 44% of participants were on GLP-1 receptor agonists, 37% on SGLT2 inhibitors, and 21% on both. Subgroup analyses showed that AID delivered consistent benefits regardless of specific medications. There was a 93% median time spent in automatic mode, suggesting strong adherence or ease of use.

Findings suggest AID may be a valuable tool for managing insulin-treated type 2 diabetes, even among patients with no prior experience using insulin pumps or carbohydrate counting methods.

© 2025 Science X Network

Jaeb Center for Health Research conducted a randomized controlled trial evaluating the impact of automated insulin delivery (AID) in adults with insulin-treated type 2 diabetes. AID significantly lowered glycated hemoglobin (HbA1c) levels and improved glucose control compared to standard insulin therapy with continuous glucose monitoring (CGM).

AID therapy resulted in a mean HbA1c reduction of 0.9 percentage points over 13 weeks, while the control group experienced a 0.3 percentage point reduction.

Automated insulin delivery systems have demonstrated benefits for patients with type 1 diabetes, yet their efficacy and safety for individuals with type 2 diabetes remain less established. Prior studies have either lacked randomized controlled designs or involved limited sample sizes, creating a gap in clinical understanding.

While medications such as glucagon-like peptide 1 (GLP-1) receptor agonists and sodium–glucose cotransporter 2 (SGLT2) inhibitors help some individuals achieve glucose targets, a substantial number of insulin-treated patients continue to struggle with glycemic control.

In the study, “A Randomized Trial of Automated Insulin Delivery in Type 2 Diabetes,” published in The New England Journal of Medicine, researchers conducted a multicenter randomized controlled trial to assess the efficacy and safety of AID in adults using multiple daily insulin injections or insulin pumps.

A total of 319 patients across 21 centers in the United States and Canada participated. Patients were randomly assigned in a 2:1 ratio to either the AID group, which received the t:slim X2 insulin pump with Control-IQ+ technology and a Dexcom G6 sensor, or the control group, which continued their pretrial insulin regimen while using real-time unblinded CGM.

Baseline HbA1c levels averaged 8.2% (±1.4) in the AID group and 8.1% (±1.2) in the control group. Over 13 weeks, HbA1c decreased to 7.3% (±0.9) in the AID group and 7.7% (±1.1) in the control group. A difference of –0.6 percentage points was observed between the groups.

CGM data indicated an increase in time spent within the target glucose range (70–180 mg/dL) from 48% (±24) to 64% (±16) in the AID group and from 51% (±21) to 52% (±21) in the control group. An adjusted difference of 14 percentage points was recorded, equating to 3.4 additional hours per day spent in the target glucose range with AID.

Additional CGM-based measures of hyperglycemia showed significant improvement in the AID group. Mean glucose levels decreased by 21 mg/dL. Time spent with glucose levels above 250 mg/dL decreased by 9.1 percentage points.

Low levels of CGM-measured hypoglycemia were observed in both groups. One severe hypoglycemia event was reported in the AID group, with no occurrences in the control group. No cases of diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome were recorded.

Some 44% of participants were on GLP-1 receptor agonists, 37% on SGLT2 inhibitors, and 21% on both. Subgroup analyses showed that AID delivered consistent benefits regardless of specific medications. There was a 93% median time spent in automatic mode, suggesting strong adherence or ease of use.

Findings suggest AID may be a valuable tool for managing insulin-treated type 2 diabetes, even among patients with no prior experience using insulin pumps or carbohydrate counting methods.

© 2025 Science X Network