A Randomized Trial of Automated Insulin Delivery in Type 2 Diabetes
Recommended Citation
Kudva YC, Raghinaru D, Lum JW, Graham TE, Liljenquist D, Spanakis EK, Pasquel FJ, Ahmann A, Ahn DT, Aleppo G, Blevins T, Kruger D, Brown SA, Levy CJ, Weinstock RS, Steenkamp DW, Spaic T, Hirsch IB, Broyles F, Rickels MR, Tsoukas MA, Raskin P, Hatipoglu B, Desjardins D, Terry AN, Singh LG, Davis GM, Schmid C, Kravarusic J, Coyne K, Casaubon L, Espinosa V, Jones JK, Estrada K, Afreen S, Levister C, O'Malley G, Liu SL, Marks S, Peleckis AJ, Pasqua MR, Tardio V, Kurek C, Luker RD, Churchill J, Tajrishi FZ, Dean A, Dennis B, Fronczyk E, Perez J, Mukhashen S, Dhillon J, Ipek A, Bzdick S, Atakov Castillo A, Driscoll M, Averkiou X, Dalton-Bakes CV, Moore A, Jordan LF, Lesniak A, Pinsker JE, Sasson-Katchalski R, Campos T, Spanbauer C, Kanapka L, Kollman C, and Beck RW. A Randomized Trial of Automated Insulin Delivery in Type 2 Diabetes. N Engl J Med 2025;392(18):1801-1812.
Document Type
Article
Publication Date
5-8-2025
Publication Title
The New England journal of medicine
Keywords
Adult, Aged, Female, Humans, Male, Middle Aged, Blood Glucose, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Hypoglycemia, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Continuous Glucose Monitoring, Young Adult, Aged, 80 and over, Treatment Outcome
Abstract
BACKGROUND: Automated insulin delivery (AID) systems have been shown to be beneficial for patients with type 1 diabetes, but data are needed from randomized, controlled trials regarding their role in the management of insulin-treated type 2 diabetes.
METHODS: In this 13-week, multicenter trial, adults with insulin-treated type 2 diabetes were randomly assigned in a 2:1 ratio to receive AID or to continue their pretrial insulin-delivery method (control group); both groups received continuous glucose monitoring (CGM). The primary outcome was the glycated hemoglobin level at 13 weeks.
RESULTS: A total of 319 patients underwent randomization. Glycated hemoglobin levels decreased by 0.9 percentage points (from 8.2±1.4% at baseline to 7.3±0.9% at week 13) in the AID group and by 0.3 percentage points (from 8.1±1.2% to 7.7±1.1%) in the control group (mean adjusted difference, -0.6 percentage points; 95% confidence interval [CI], -0.8 to -0.4; P< 0.001). The mean percentage of time that patients were in the target glucose range of 70 to 180 mg per deciliter increased from 48±24% to 64±16% in the AID group and from 51±21% to 52±21% in the control group (mean difference, 14 percentage points; 95% CI, 11 to 17; P< 0.001). All other multiplicity-controlled CGM outcomes reflective of hyperglycemia that were measured were significantly better in the AID group than in the control group. The frequency of CGM-measured hypoglycemia was low in both groups. A severe hypoglycemia event occurred in one patient in the AID group.
CONCLUSIONS: In this 13-week, randomized, controlled trial involving adults with insulin-treated type 2 diabetes, AID was associated with a greater reduction in glycated hemoglobin levels than CGM alone. (Funded by Tandem Diabetes Care; 2IQP ClinicalTrials.gov number, NCT05785832.).
Medical Subject Headings
Adult; Aged; Female; Humans; Male; Middle Aged; Blood Glucose; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Hypoglycemia; Hypoglycemic Agents; Insulin; Insulin Infusion Systems; Continuous Glucose Monitoring; Young Adult; Aged, 80 and over; Treatment Outcome
PubMed ID
40105270
ePublication
ePub ahead of print
Volume
392
Issue
18
First Page
1801
Last Page
1812
