Jul 2026· Journal of Diabetes Science and Technology· pp.
19322968261465689
· 0 citations· 10 references
Medicine
TL;DR
Active insulin time is a key modifiable parameter influencing AB delivery and glycemic outcomes, and shorter AIT settings were associated with increased AB administration and improved TIR, whereas glucose target settings had no significant impact on these outcomes.
Abstract
Background
This study examined how automatic correction boluses (ABs) vary according to active insulin time (AIT) and glucose target settings, and how these parameters impact glycemic control in individuals with type 1 diabetes.
Methods
Retrospective data from 287 individuals with type 1 diabetes using the MiniMed 780G system in auto-mode for at least 80% of the time over a minimum period of 6 months were analyzed. The AB delivery was evaluated in relation to different AIT and glucose target settings. Glycemic outcomes, including time in range (TIR 70-180 mg/dL), were assessed.
Results
Automatic correction boluses accounted for 33.1% of bolus insulin and 18.3% of the total daily insulin dose (TDD). Active insulin time settings significantly influenced AB delivery: individuals using a 2-hour AIT showed higher percentages of ABs relative to both TDD and bolus insulin, as well as higher AB doses expressed in IU/kg/day. Shorter AIT settings were also associated with improved TIR. In contrast, glucose target settings ranging from 100 to 120 mg/dL did not significantly affect AB delivery or TIR.
Conclusion
Active insulin time is a key modifiable parameter influencing AB delivery and glycemic outcomes. Shorter AIT settings were associated with increased AB administration and improved TIR, whereas glucose target settings had no significant impact on these outcomes.
Introduction Diabetes self-management in older adults with type 1 diabetes (T1D) presents a unique clinical challenge, since maintaining tight glycemic control must be carefully weighed against age-related vulnerabilities. This study aimed to analyze glycemic control through the effects of customized algorithm settings in a cohort of older adults with T1D using an automated insulin delivery (AID) system. Methods This retrospective real-world data analysis included users of the MiniMed™ 780G AID system, aged ≥60 years. Continuous glucose monitoring (CGM) data including time in range (TIR; 70–180 mg/dL; 3.9–10.0 mmol/L), time in tight range (TITR; 70–140 mg/dL; 3.9–7.8 mmol/L), time below range (TBR; <70 mg/dL; <3.9 mmol/L), level 2 TBR (<54 mg/dL; <3.0 mmol/L) and time above range (TAR; >180 mg/dL; >10.0 mmol/L) were analyzed alongside algorithm settings and daily insulin use. Group comparisons utilized standard parametric and non-parametric statistical tests. A multivariable logistic regression model identified independent clinical predictors of high glycemic performance (TITR ≥50%). Results The cohort comprised 97 AID users (70.1% female, mean age 67.9 ± 6.7; range 60–90 years). Overall glycemic control was good, with mean TIR 76.1%, TITR 51.1% and TBR 1.1%. Fourteen participants (14.4%) used the manufacturer’s recommended optimal settings (ROS); i.e., target glucose of 5.5 mmol/L and active insulin time of 2 hours. CGM metrics did not differ between ROS and non-ROS users for TIR, TITR and TBR. When stratifying the cohort by glycemic performance, 55 participants (56.7%) reached TITR ≥50%; however, the adoption of ROS in high (≥50%) TITR and lower (<50%) TITR subgroups was similar (16.4% vs 11.9%; Fisher p=0.58). When compared to the lower TITR subgroup, participants in the high TITR subgroup delivered less auto-correction insulin (14.2% vs 20.6%, p<0.001) and a higher proportion of manual bolus insulin (46.1% vs 35.2%, p<0.001), which remained a significant predictor of high TITR after multivariable adjustment. TBR was significantly higher in the high (≥50%) TITR subgroup, although it remained low in absolute terms (1.5% vs. 0.8%; p=0.017). Conclusion While the MiniMed™ 780G AID system use is associated with low CGM-derived hypoglycemia exposure and highly effective glycemic control, regardless of customized settings, superior glycemic control is associated with a higher proportion of user-initiated manual boluses. The algorithm supports, but cannot replace, user engagement.
Š. Volčanšek, P. Vidmar, A. Janež et al.· Frontiers in Endocrinology· 0 citations
Objective measures of self-management are critical for understanding glycemic outcomes in individuals with type 1 diabetes (T1D). The mealtime insulin bolus score (BOLUS), derived from insulin pump data, is a validated indicator of mealtime insulin engagement in pediatric T1D populations, but its validity in emerging adults (EA) is unknown. We examined associations between BOLUS scores and glycemic outcomes (HbA1c and continuous glucose monitoring metrics) in 347 EA with T1D (ages 18-22). Higher BOLUS scores were associated with lower HbA1c (r = -0.24, P < 0.001), greater time in range (r = 0.23, P < 0.001), and lower time above range (r = -0.23, P < 0.001). The mean BOLUS score (1.17) was substantially lower than the previously reported mean pediatric BOLUS score. Findings support the validity of BOLUS as an objective behavioral measure in EA with T1D and highlight reduced mealtime insulin engagement during this developmental period.
Jessica S. Pierce, Mark A. Clements, Brent Lockee et al.· Diabetes Technology & Therap...· 0 citations
Randomized and real-world studies demonstrate that AID systems significantly improve A1C and time in range while minimizing hypoglycemia, without increasing treatment complexity or patient burden, and position AID as a practical and effective strategy to overcome long-standing therapeutic inertia in type 2 diabetes.
Z. Tariq, Grazia Aleppo, Anders L Carlson et al.· Endocrine Practice· 0 citations
The successful management of type-1 diabetes (T1D) and insulin-dependent type-2 diabetes depends on the ability to accurately calibrate bolus and basal insulin doses, and minimize the time spent with high postprandial blood glucose (BG) levels while avoiding dangerously low hypoglycemic excursions. Precise calibration of the insulin pump helps with successful disease management; however, people with T1D may still experience prolonged, potentially damaging BG levels due to postprandial highs. Insulin pumps offer large, currently underexploited degrees of freedom in insulin delivery, which can have a dramatic impact on average postprandial BG levels. Building on existing models of the glucose-insulin system, we first propose a simple, automated, and individualized insulin-pump calibration system based on a series of measures taken before and a few hours after carbohydrate ingestion. We then modulate the shape of pre-meal insulin dosing to explicitly reduce postprandial BG levels while minimizing the likelihood of dangerously low BG. Such an optimal insulin delivery time course can potentially improve postprandial BG levels and rapidly bring BG to the target level. We evaluated our methods in 20 patients over 4 days, with BG levels sampled frequently.
I. Aganj, N. Bryant, Leah (Morgan) Panaro et al.· medRxiv· 0 citations
INTRODUCTION
Clinical inertia and the complexity of basal insulin titration are major barriers to optimal glycemic control in adults with type 2 diabetes (T2D). A prototype of the Dexcom Smart Basal system known as basal therapy optimization (BTO), a continuous glucose monitoring (CGM)-informed basal insulin optimization system, was evaluated for its efficacy, safety, and impact on patient-reported outcomes (PRO).
METHODS
In this prospective, single-arm study, 14 adults with T2D (three initiating and 11 optimizing basal insulin) used the BTO system. The study consisted of three phases: a ten-day baseline, up to 35 days of active titration, and a 20-day post-titration follow-up. Outcomes included change in CGM-derived glycemic metrics (mean glucose, time in range [TIR], time above range [TAR], time below range [TBR]), fasting blood glucose (FBG), and PROs (diabetes treatment satisfaction, glucose monitoring satisfaction, and patient-doctor depth of relationship) assessed using validated questionnaires. Safety was also assessed by the number of adverse events.
RESULTS
All participants completed the study. The BTO system generated 401 insulin dose recommendations, with 96.5% accepted by the healthcare provider. After BTO-guided titration, mean glucose decreased by median (IQR) 26.3 (- 64.6, - 6.0) mg/dl (p = 0.0031), TIR 70-180 mg/dl increased by 16.0 (2.5, 43.7) percentage points (p = 0.0017), TAR > 180 mg/dl decreased by 15.9 (- 43.7, - 2.5) percentage points (p = 0.0017), and TBR < 70 mg/dl remained low (0.0-0.1%), with no clinically significant change in TBR. Median FBG decreased by 17.8 (- 54.4, 2.3) mg/dl (p = 0.052). No BTO- or study-related- adverse or severe adverse events were reported. Treatment satisfaction was significantly higher; median post-titration Diabetes Treatment Satisfaction Questionnaire (DTSQ) Change score was 17 (14, 18) on a scale ranging from - 18 to 18 and was significantly different from baseline DTSQ status score (p = 0.001). High satisfaction with glucose management and strong patient-provider relationships were preserved. Three illustrative cases highlighted successful insulin dose optimization through dose increases or decreases.
CONCLUSIONS
CGM-informed basal insulin optimization with a prototype of Dexcom Smart Basal was associated with improvements in glycemic control and treatment satisfaction in adults with T2D, with a favorable safety profile. The system may help overcome clinical inertia and support individualized insulin titration in real-world settings.
TRIAL REGISTRATION
ClinicalTrials.gov identifier NCT07681375 (Submitted for retrospective registration on 1/28/2026 and registered on 7/1/2026).
S. Oser, C. Crystal, K. Hames et al.· Diabetes Therapy· 0 citations
To evaluate efficacy and safety of continuous glucose monitoring (CGM) and automated insulin delivery (AID) in infants. A retrospective multicenter study (13 centers) of 76 children diagnosed with antibody-positive type 1 diabetes before age 2. Outcomes at 12 months were compared between AID users (n = 47) and multiple daily injections (MDI)/SAP users (n = 29). AID systems included Medtronic 780 G (38%), Tandem Control-IQ (38%), and CamAPS FX (24%). CGM median wear time was 97.0% (93.3; 98.1). AID users achieved significantly higher TIR (65% vs. 56%, P = 0.041) and time in tight range (TITR) (42% vs 32.5%, P = 0.038). In multivariable regression, AID was the sole independent predictor of lower HbA1c (P = 0.035). Zero severe hypoglycemia (SH) events occurred in the AID group (vs. 7.1% in MDI/SAP). Use of CGM is safe in very young children, with AID systems proving superior to traditional therapy. This real-world evidence supports incorporating AID consideration into future international guidelines from the time of pediatric diagnosis.
M. Marigliano, A. Scaramuzza, C. Arnaldi et al.· Diabetes Technology & Therap...· 0 citations
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