Diabetes technology & therapeutics · 2026
Three-Year Durability of Automated Insulin Delivery Therapy in Children and Adolescents with Type 1 Diabetes: A Multicenter Real-World Study.
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Bombaci Bruno, Lombardo Fortunato, Bassi Marta, Minuto Nicola, Tornese Gianluca, Catamo Eulalia, Bonfanti Riccardo, Rigamonti Andrea, Reinstadler Petra, Kalapurackal Mila A, Mameli Chiara, Zuccotti Gianvincenzo, Maffeis Claudio, Piona Claudia, Delvecchio Maurizio, Arnaldi Claudia, Felappi Barbara, Mozzillo Enza, Roppolo Rosalia, Maltoni Giulio, Lo Presti Donatella, Pezzino Giulia, Zanfardino Angela, Salzano Giuseppina, Passanisi Stefano, ISPED Diabetes Group Study Collaborators
Аннотация
INTRODUCTION: Evidence on the long-term durability of glycemic control beyond the first year of automated insulin delivery therapy remains limited, particularly in large multicenter pediatric cohorts. The present study aimed to evaluate long-term effectiveness and identify determinants of sustained optimal outcomes over 3 years of MiniMed™ 780G use in youth with type 1 diabetes (T1D).
MATERIALS AND METHODS: In this longitudinal, multicenter, real-world study, 359 youth with T1D (median age 12.2 years, 50.9% female) from 20 Italian pediatric diabetes centers were followed for 3 years after MiniMed 780G initiation. Glucose metrics, insulin delivery parameters, device settings, and engagement indicators were analyzed at 1, 2, and 3 years. Longitudinal changes were assessed using linear mixed-effects models. Multivariable logistic regression identified predictors of achieving time in tight range target (TITR ≥ 50%) at 3 years.
RESULTS: Median time in range (TIR) remained within international targets but declined modestly from 75% at 1 year to 74% at 3 years (P = 0.002). The percentage of automatic correction boluses increased over time, whereas user-initiated boluses and carbohydrate entries declined (P < 0.001). Youth with higher TIR at 1 year showed a progressive reduction in TIR and greater increase in automated corrections (time × group interaction P < 0.001). At 3 years, higher SmartGuard use (odds ratio [OR]: 1.13, 95% confidence interval [CI]: 1.03-1.23; P = 0.007), optimal system settings (OR: 3.21, 95% CI: 1.33-7.77; P = 0.010), and lower automatic correction boluses (OR: 0.84, 95% CI: 0.80-0.89; P < 0.001) were independently associated with achieving TITR ≥50%.
CONCLUSIONS: MiniMed 780G provides sustained glycemic control over 3 years. However, progressive reliance on automated corrections and reduced user engagement may attenuate tight glycemic control, highlighting the need for ongoing education and proactive device optimization.
MATERIALS AND METHODS: In this longitudinal, multicenter, real-world study, 359 youth with T1D (median age 12.2 years, 50.9% female) from 20 Italian pediatric diabetes centers were followed for 3 years after MiniMed 780G initiation. Glucose metrics, insulin delivery parameters, device settings, and engagement indicators were analyzed at 1, 2, and 3 years. Longitudinal changes were assessed using linear mixed-effects models. Multivariable logistic regression identified predictors of achieving time in tight range target (TITR ≥ 50%) at 3 years.
RESULTS: Median time in range (TIR) remained within international targets but declined modestly from 75% at 1 year to 74% at 3 years (P = 0.002). The percentage of automatic correction boluses increased over time, whereas user-initiated boluses and carbohydrate entries declined (P < 0.001). Youth with higher TIR at 1 year showed a progressive reduction in TIR and greater increase in automated corrections (time × group interaction P < 0.001). At 3 years, higher SmartGuard use (odds ratio [OR]: 1.13, 95% confidence interval [CI]: 1.03-1.23; P = 0.007), optimal system settings (OR: 3.21, 95% CI: 1.33-7.77; P = 0.010), and lower automatic correction boluses (OR: 0.84, 95% CI: 0.80-0.89; P < 0.001) were independently associated with achieving TITR ≥50%.
CONCLUSIONS: MiniMed 780G provides sustained glycemic control over 3 years. However, progressive reliance on automated corrections and reduced user engagement may attenuate tight glycemic control, highlighting the need for ongoing education and proactive device optimization.