Introduction and Objective: Steroid-induced hyperglycemia poses a significant management challenge in hospitalized patients with diabetes, with limited data to inform best practices. We compared automated insulin delivery (AID) with multiple daily injections plus continuous glucose monitoring (MDI+CGM) to assess inpatient glycemic outcomes. Methods: In this inpatient randomized controlled trial, adults with type 1 or type 2 diabetes receiving corticosteroids (≥10mg prednisone) were assigned to AID or to continue MDI. Both groups received real-time CGM. The primary endpoint was time in range (70-180 mg/dl). Key secondary endpoints: mean glucose, time above range, and time below 70 mg/dl. Results: Thirty-nine hospitalized participants receiving corticosteroids (prednisone-equivalent dose range: 10-1,250 mg) were assigned to AID (n=19; 62± 13 years; A1c 7.6%) or MDI+CGM (n=20, 60±11 years, A1c 8.1%). The mean percentage of time participants were in the target glucose range of 70 to 180 mg/dL was 69±14% in the AID group vs 44±21% in the control group (adj difference, 27%, 95% CI, 21 to 34, p0.001), Figure. Mean glucose was lower with AID compared to control (161± 21 vs 199 ± 34 mg/dL, p0.001). Patients on AID spent 14% less time 250 (95% CI, -18 to -9%). There was no difference in time below 70 or 54 mg/dL. Conclusion: AID was associated with higher time in range than MDI+CGM in patients with diabetes exposed to corticosteroids in the hospital. Disclosure S. Brown: Research Support; Current; Insulet Corporation, Tandem Diabetes Care, Inc., Dexcom, Inc. Research Support; Ended; Roche Diabetes Care, Tolerion, Inc. R. Lal: Consultant; Current; Abbott Diabetes, Adaptyx Biosciences. Consultant; Ended; Biolinq, Capillary Biomedical, Deep Valley Labs. Consultant; Current; Gluroo, Portal Diabetes, Tidepool. Advisory Panel; Ended; ProventionBio, Lilly, Sanofi, Rezolute. M.S. Hughes: Consultant; Current; Dexcom, Inc., Sanofi, Sequel Med Tech, LLC. T. Akcan: None. M. Basina: None. J. Kirby: Stock/Shareholder; Current; PS Fertility. R. Parab: None. J.M. Feeley: Research Support; Current; Dexcom, Inc. M. Stumpf: None. K. Miller: None. J.C. Costin: None. N. Reyes: None. M.C. Sanchez Valenzuela: None. Z. Wen: None. C. Alix: None. L. Chadalawada: None. M. Weber: None. T. Idrees: Research Support; Current; AbbVie Inc. R.S. Kingman: None. B. Suh: None. M. Morgan: None. Y. Liu: None. M. Lee: None. M. Tan: Advisory Panel; Ended; Vertex Pharmaceuticals Incorporated. Consultant; Current; Novo Nordisk, Amylyx. K. Kingston: None. L. Peng: None. R.W. Beck: Research Support; Current; MannKind Corporation, Abbott Diabetes, Dexcom, Inc., Tandem Diabetes Care, Inc., Sequel Med Tech, DreaMed Diabetes, Ltd. Consultant; Ended; Novo Nordisk, Eli Lilly and Company. Consultant; Current; Zucara Therapeutics. G. Davis: Research Support; Current; Insulet Corporation, Sequel Med Tech. F.J. Pasquel: Research Support; Current; Dexcom, Inc., Insulet Corporation, Ideal Medical Technologies. Research Support; Ended; Novo Nordisk, Tandem Diabetes Care, Inc. Consultant; Ended; Insulet Corporation. Funding The National Institute of Diabetes and Digestive and Kidney Diseases (R01DK138366), with device support from Insulet and Dexcom, Inc.
BROWN et al. (Fri,) studied this question.