Diabetes technology & therapeutics · 2026
Automated Insulin Delivery Reduces the Risk of Diabetic Retinopathy in Adults with Type 1 Diabetes: A Prospective Cohort Study.
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Nattero-Chávez Lía, de Lope Quiñones Sara, Quintero Tobar Alejandra, de la Calle de la Villa Esther, Bayona Ane, Ruiz Gracia Teresa, Escobar-Morreale Héctor F, Luque Ramírez Manuel
Аннотация
AIMS: To evaluate the impact of automated insulin delivery (AID) systems on the incidence and progression of diabetic retinopathy (DR) in adults with type 1 diabetes (T1D) compared with multiple daily injections (MDI).
METHODS: This prospective cohort study followed 379 adults with T1D for a mean of 4.9 ± 1.4 years. DR was assessed via standardized retinal imaging. At baseline, 80 participants used AID, and 35 initiated AID during follow-up; 264 remained on MDI. Outcomes included baseline DR prevalence, incident DR, and DR progression. Multivariate Poisson and Cox regression models adjusted for key covariates (age, diabetes duration, pre-baseline HbA1c) were used, with propensity score-matched and HbA1c trajectory analyses as sensitivity checks.
RESULTS: DR prevalence at baseline was 13.9% with no group differences. Incident DR was lower among AID users (6.1% vs. 18.9% in MDI; hazard ratio = 0.33, 95% confidence interval: 0.13-0.73; P = 0.01; number needed to treat = 8). DR progression and all vision-threatening events occurred only in the MDI group (41.7% vs. 0%; P < 0.001). Use of AID systems resulted in a greater reduction in HbA1c compared with MDI (-0.32% vs. -0.06%; P = 0.01).
CONCLUSIONS: AID systems were associated with improved glycemic control and reduced incidence and progression of DR in adults with T1D. These findings support AID use to prevent early microvascular complications.
METHODS: This prospective cohort study followed 379 adults with T1D for a mean of 4.9 ± 1.4 years. DR was assessed via standardized retinal imaging. At baseline, 80 participants used AID, and 35 initiated AID during follow-up; 264 remained on MDI. Outcomes included baseline DR prevalence, incident DR, and DR progression. Multivariate Poisson and Cox regression models adjusted for key covariates (age, diabetes duration, pre-baseline HbA1c) were used, with propensity score-matched and HbA1c trajectory analyses as sensitivity checks.
RESULTS: DR prevalence at baseline was 13.9% with no group differences. Incident DR was lower among AID users (6.1% vs. 18.9% in MDI; hazard ratio = 0.33, 95% confidence interval: 0.13-0.73; P = 0.01; number needed to treat = 8). DR progression and all vision-threatening events occurred only in the MDI group (41.7% vs. 0%; P < 0.001). Use of AID systems resulted in a greater reduction in HbA1c compared with MDI (-0.32% vs. -0.06%; P = 0.01).
CONCLUSIONS: AID systems were associated with improved glycemic control and reduced incidence and progression of DR in adults with T1D. These findings support AID use to prevent early microvascular complications.