Introduction: Automated insulin delivery (AID) systems for type 1 diabetes (T1D) improve HbA1C, increase time-in-range, and reduce hypoglycemia. However, starting AID systems involves multiple steps, from decision to initiation. This study quantified time to AID initiation (TT-AID) and factors influencing the timeline. Methods: This retrospective study included adults with T1D at an academic diabetes center in Baltimore, Maryland who were on multiple daily injections and initiated an AID system for the first time since diagnosis from May 2022 to March 2025. Demographics and dates of AID decision, AID selection visit (optional), prescription, training, and initiation were extracted from electronic medical records. Time to AID initiation was measured, with differences by insurance and AID selection visit assessed using Wilcoxon rank-sum and log-rank tests. Results: Participants included 114 adults with T1D median age 38.9 years, 57% male, 21% Black, 75% commercial insurance, median diabetes duration 10.2 years (IQR = 3.5, 18.1). The median TT-AID was 89.5 days (IQR = 49, 132). The longest delay was between decision and training median: 82.5 days (IQR = 43, 122). Patients attending the optional AID selection visit had significantly longer TT-AID compared with those who did not 112 (IQR = 79, 144) vs 55 (IQR = 35, 98) days, P ≤ .0001. Time to AID system initiation did not differ by AID type ( P = .74). Patients with commercial insurance initiated AID systems sooner than those with public insurance, 86 days (IQR = 69, 98) vs 122 (IQR = 67, 195), P = .03 within 6 months of decision. Conclusion: Adults took roughly 3 months to initiate AID, with longer delays among those with public insurance and those attending AID selection visits. Streamlining AID system initiation may reduce delays and optimize outcomes.
Valdez et al. (Fri,) studied this question.