Switch of Open-Source Automated Insulin Delivery (AID) System—AndroidAPS to Commercially Available AID Systems in Type 1 Diabetes: The Extension of the CODIAC Study

Objective: This study was designed to investigate the switch between the open-source automated insulin delivery (OS-AID) system AndroidAPS (AAPS) and commercially available AID systems Control-IQ (CIQ) and MiniMed 780G (780G) conducted in a new extended follow-up study. Research Design and Methods: In this prospective open-label single-arm clinical trial, 41 adults with type 1 diabetes (age 35 ± 11 years, glycated hemoglobin [HbA1c] 6.4 ± 2.8% [46 ± 6.8 mmol/mol]) who have voluntarily used AAPS entered a total of three study phases. In the first phase, participants continued with AAPS for 3 months. In the second 3-month study phase, all participants initiated CIQ (n = 25) or 780G (n = 16). Finally, participants were switched back to the AAPS for the last 3 months phase. Results of the treatment with commercially available AID systems were compared with both AAPS phases. Results: Commercially available systems were comparable to AAPS in achieving time in range (TIR) (84.2 ± 7.6 vs. 85 ± 6.9%; P = 0.31) and in HbA1c (6.4 ± 3 vs. 6.3 ± 2.7% [46 ± 8.8 vs. 45.7 ± 6.2 mmol/mol]; P = 0.68). In contrast, time in tight range (TITR) was significantly higher in AAPS (66.38 ± 11.84 vs. 63.4 ± 11.77, P = 0.035). However, the time in hypoglycemia <70 mg/dL [<3.9 mmol/L] was significantly lower with commercially available AID systems (2.2 ± 1.2 vs. 3.8 ± 1.9%; P < 0.001). These results were consistent after switching back to AAPS. Conclusion: The extension of the Comparison of Different Hybrid Closed-Loop Systems-AndroidAPS and Control-IQ-in adults with Type 1 Diabetes study is the only prospective study to investigate switching between OS and commercially available AID systems. The switch from AAPS to commercially available systems was not associated with a change in TIR. However, the use of AAPS was associated with a higher TITR, but also with a higher risk of hypoglycemia.