Konantambigi Akash, Wang Wenyong, Boggild Dylan, Rana Arushi, Syphers Larisa, Presley Catherine, Cummins Candice, Malabu Usman, Hawke Kate, Shenoy Vasant, Puri Gaurav, Deshmukh Harshal
Mackay Hospital and Health Service, Mackay, Queensland, Australia.
James Cook University, Townsville, Queensland, Australia.
Diabetes Obes Metab. 2025 Aug;27(8):4436-4445. doi: 10.1111/dom.16485. Epub 2025 May 28.
Automated insulin delivery (AID) systems, which integrate continuous glucose monitoring (CGM) with automated insulin dosing, have emerged as a transformative therapy. However, real-world data on AID effectiveness, particularly in regional Australia, remain limited.
We conducted a retrospective audit across three Australian hospital sites-Logan (metropolitan), Mackay and Townsville (regional)-to evaluate the impact of AID therapy in adults with Type 1 Diabetes Mellitus (T1DM). Data on demographics, comorbidities, CGM metrics and clinical outcomes were extracted from medical records and device platforms. The primary outcome was change in HbA1c and CGM time-in-range (TIR; 3.9-10 mmol/L) at follow-up. Follow-up data were recorded up to 12 months following AID commencement. Secondary outcomes included changes in body weight, glycaemic variability and predictors of HbA1c reduction.
The study consisted of 158 people living with T1DM who were initiated on AID. Following AID initiation, mean TIR improved from 53.4% (SD 21.1%) to 70.0% (SD 14.6%) (p < 0.0001), and time in hyperglycaemia (>13.9 mmol/L) declined from 18.7% (SD 19.4%) to 8.4% (SD 9.31%) (p < 0.0001). The mean HbA1c significantly decreased from 8.62% (SD 1.70) at baseline to 7.34% (SD 1.31) at follow-up across the entire study cohort (p < 0.0001), with 42.7% achieving <7% and 64.1% achieving <7.5% at follow-up. Multivariable regression identified higher baseline HbA1c (p < 0.0001) as a significant predictor of HbA1c reduction. Improvements were consistent across AID system types and geographical settings.
AID therapy significantly improves glycaemic control in adults with T1DM in both regional and metropolitan Australia. Our findings support the real-world effectiveness of AID systems and highlight their potential to bridge care gaps across diverse settings.
自动胰岛素给药（AID）系统将连续血糖监测（CGM）与自动胰岛素给药相结合，已成为一种变革性疗法。然而，关于AID有效性的真实世界数据，尤其是在澳大利亚地区，仍然有限。
我们对澳大利亚的三个医院站点——洛根（大都市地区）、麦凯和汤斯维尔（地区）——进行了一项回顾性审计，以评估AID疗法对1型糖尿病（T1DM）成人患者的影响。从医疗记录和设备平台中提取了人口统计学、合并症、CGM指标和临床结果的数据。主要结局是随访时糖化血红蛋白（HbA1c）的变化和CGM血糖在目标范围内的时间（TIR；3.9 - 10 mmol/L）。随访数据记录至AID开始后的12个月。次要结局包括体重变化、血糖变异性以及HbA1c降低的预测因素。
该研究包括158名开始接受AID治疗的T1DM患者。开始AID治疗后，平均TIR从53.4%（标准差21.1%）提高到70.0%（标准差14.6%）（p < 0.0001），高血糖时间（>13.9 mmol/L）从18.7%（标准差19.4%）降至8.4%（标准差9.31%）（p < 0.0001）。整个研究队列的平均HbA1c从基线时的8.62%（标准差1.70）显著降至随访时的7.34%（标准差1.31）（p < 0.0001），随访时有42.7%的患者HbA1c < 7%，64.1%的患者HbA1c < 7.5%。多变量回归分析确定较高的基线HbA1c（p < 0.0001）是HbA1c降低的显著预测因素。在不同类型的AID系统和地理环境中，改善情况是一致的。
在澳大利亚的地区和大都市地区，AID疗法显著改善了T1DM成人患者的血糖控制。我们的研究结果支持了AID系统在现实世界中的有效性，并突出了它们在弥合不同环境下护理差距方面的潜力。
