What question did this study set out to answer?

The goal was to determine if residual β-cell function provides additional glycemic benefits in new-onset type 1 diabetes using automated insulin delivery.

June 7, 2026

1062-OR: Residual β-Cell Function Confers Glycemic Benefit beyond Automated Insulin Delivery in New-Onset Type 1 Diabetes

Key Points

The goal was to determine if residual β-cell function provides additional glycemic benefits in new-onset type 1 diabetes using automated insulin delivery.
Analyzed patient-level continuous glucose monitoring data from individuals with new-onset stage 3 type 1 diabetes in randomized trials.
Used linear mixed-effects models to compare CGM metrics and evaluate the role of C-peptide levels.
Participants stratified by residual C-peptide levels were compared to non-diabetic controls and adults with established type 1 diabetes.
Residual C-peptide was linked to significant improvements in CGM metrics (time in range, time in tight range, and time above range, all p < 0.001).
The benefit of automated insulin delivery diminished with higher C-peptide levels (interaction p = 0.021).
Findings indicate that while automated insulin delivery enhances glycemic control, endogenous insulin secretion remains advantageous.

Abstract

Introduction and Objective: Automated insulin delivery (AID) improves glycemic outcomes in type 1 diabetes (T1D), raising questions about the added value of preserving endogenous β-cell function. We examined whether residual β-cell function adds benefit in new-onset T1D using AID. Methods: Patient-level CGM data were analyzed from individuals with new-onset, stage 3 T1D enrolled in randomized trials of hybrid closed-loop AID (CLVR n=88; CLOUD n=97). CGM data required ≥3 days of wear. CGM metrics were compared using linear mixed-effects models with treatment, log-transformed C-peptide AUC, and their interaction, and study as fixed effects, and participant-level random intercepts. For visualization, participants were stratified by C-peptide and compared with non-diabetic controls (n=153) and adults with established T1D (n=25). Results: Residual C-peptide was strongly associated with improved CGM metrics, including time in range, time in tight range, and time above range (all p 0.001). The incremental benefit of AID was greatest at low C-peptide and diminished with increasing C-peptide (interaction p = 0.021). Conclusion: While AID improves glycemic control, it does not eliminate the biological advantage of endogenous insulin secretion; residual β-cell function provides additional benefit beyond technology alone. CGM captures biologically meaningful differences, supporting CGM-based endpoints for trials evaluating β-cell-preserving therapies. Disclosure A. Lam: Advisory Panel; Ended; Vertex Pharmaceuticals Incorporated. T. Bakhtiyarli: None. A.L. Carr: None. C.K. Boughton: Consultant; Current; CamDiab Ltd. Research Support; Current; Abbott Diabetes, Dexcom, Inc., Ypsomed AG. R. Hovorka: Board Member; Current; CamDiab Ltd. Consultant; Current; Abbott Diabetes. Research Support; Current; Abbott Diabetes, Dexcom, Inc., Ypsomed AG, Novo Nordisk Foundation. Other - Speaker bureau; Ended; Novo Nordisk, Eli Lilly and Company. P. Taylor: None. C.M. Dayan: Consultant; Current; Sanofi, SAB Biotherapeutics, Inc., Immunocore, Ltd. Consultant; Ended; Vertex Pharmaceuticals Incorporated. Consultant; Current; Quell. Advisory Panel; Current; Amarna, ArgenX, Amgen Inc. J.A. Hedrick: None. P. Senior: Consultant; Ended; Abbott. Consultant; Current; Dexcom, Inc. Consultant; Ended; GlaxoSmithKline plc. Research Support; Current; Eli Lilly and Company. Consultant; Current; Novo Nordisk, Sana Biotechnology Inc., Sanofi, Vertex Pharmaceuticals Incorporated. Consultant; Ended; Ypsomed AG.

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Cite This Study

LAM et al. (Fri,) studied this question.

synapsesocial.com/papers/6a250b0e7def13d035e1b0af https://doi.org/https://doi.org/10.2337/db26-1062-or

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