What question did this study set out to answer?

The study aims to evaluate the real-world effectiveness of automated insulin delivery systems on glycemic control in adults with type 1 diabetes.

January 25, 2026Open Access

Automated Insulin Delivery Associated with Superior Glycemic Outcomes in Type 1 Diabetes: A Swedish National Registry Analysis

Key Points

The study aims to evaluate the real-world effectiveness of automated insulin delivery systems on glycemic control in adults with type 1 diabetes.
Retrospective cohort study using data from the Swedish National Diabetes Register
Inclusion of adults (≥18 years) with type 1 diabetes from 2014 to 2024
Assessment of hemoglobin A1c values averaged per person-year
Comparison of various insulin delivery methods including automated systems and traditional methods
Mixed-model regression analysis adjusting for multiple covariates such as age, diabetes duration, and clinic size.
Automated insulin delivery systems showed significantly lower HbA1c compared to multiple daily injections with CGM.
Tandem Control-IQ technology demonstrated the greatest reduction in HbA1c (β = −4.8 mmol/mol).
Medtronic 780G and 670G also showed considerable HbA1c improvement.
Continuous subcutaneous insulin infusion with CGM outperformed MDI-CGM.
Findings were consistent with prior randomized controlled trials and international datasets.

Abstract

Background: Automated insulin delivery (AID) systems integrate continuous glucose monitoring (CGM) and insulin pumps with algorithms that adjust insulin delivery. While randomized controlled trials (RCTs) demonstrate improvements in glycemic outcomes with AID, large-scale real-world data (RWD) analyses are needed to evaluate performance in routine care. Methods: This retrospective, registry-based cohort study included adults (≥18 years) with type 1 diabetes (T1D) in the Swedish National Diabetes Register (NDR) from 2014 to 2024. Hemoglobin (Hb)A1c values were averaged per person-year and aggregated by clinic. Insulin delivery/glucose monitoring combinations included multiple daily injections (MDIs) with blood glucose meter (MDI-BG), MDI with CGM (MDI-CGM, reference), conventional continuous subcutaneous insulin infusion with blood glucose meter (CSII-BG), CSII with CGM (CSII-CGM), and AID systems (Tandem Control-IQ technology, Medtronic 670G, and Medtronic 780G). Mixed-model regression assessed HbA1c outcomes, with treatment, year, age, diabetes duration, gender, body mass index, physical activity level, smoking habits, and clinic size as fixed effects; with random effects for clinics; and weighting by clinic sample size. Results: After adjusting for the covariates, AID systems were associated with significantly lower HbA1c compared with MDI-CGM: β = −4.0 mmol/mol (95% confidence interval CI −4.3 to −3.7, P < 0.001), with individual system effects, Tandem Control-IQ technology β = −4.8 mmol/mol (95% CI −5.2 to −4.5, P < 0.001), Medtronic 780G β = −3.1 (−3.5 to −2.7, P < 0.001), and Medtronic 670G β = −2.9 (95% CI −3.5 to −2.4, P < 0.001). CSII-CGM also outperformed MDI-CGM: β = −1.7 mmol/mol (95% CI −1.9 to −1.4, P < 0.001). Differences between the Tandem and Medtronic AID systems were significant ( P < 0.001). Conclusions: In a nationwide RWD analysis, AID use was consistently associated with clinically and statistically significant HbA1c reductions in adults with T1D, with the greatest effect for Tandem Control-IQ technology. These findings align with RCTs and international RWD, supporting AID as a preferred technology in routine diabetes care for T1D.

Automated Insulin Delivery Associated with Superior Glycemic Outcomes in Type 1 Diabetes: A Swedish National Registry Analysis

Key Points

Abstract

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