Insights into the effective use of the Smart MDI system: Data from the first 1852 type 1 diabetes users

Aims The study analysed real‐world data of people with type 1 diabetes (PWT1D) using the Smart Multiple Daily Insulin (MDI) system with the aim of assessing associations between user interaction behaviours and parameters of glycaemic control to provide educational insights for optimal system use. Methods A retrospective cohort analysis was conducted using data from 1852 PWT1D users of the Smart MDI system across 21 countries. The system comprises the InPen™ insulin injector, Simplera™ CGM, and the InPen™ phone application. Users were included if they had at least 10 days of InPen and CGM data. Glycaemic outcomes were correlated with user interaction, focusing on responses to missed dose alerts (MDA) and correct high glucose alerts (CHGA). Results The mean time in range (TIR) was 55.7%, with users responding with a bolus dose to 49.3% of MDA and 46.6% of CHGA. However, those users who responded within 1 h to over 75% of alerts with a bolus dose achieved higher TIRs of 67.2% (MDA) and 71.5% (CHGA). Prompt responses (within 10 min) showed greater TIR. The study highlighted significant associations between alert responsiveness and better glycaemic outcomes without increased hypoglycaemia risk. Conclusions User engagement with the Smart MDI system is crucial for optimal glycaemic outcomes. The study underscores the need for structured education on system use and alert responses. While causality cannot be confirmed, the findings suggest that proactive user interactions contribute to meeting glycaemic targets. Further research is needed to explore these relationships and enhance educational strategies.