Introduction and Objective: Hospitalized patients with diabetes and elevated hemoglobin A1c levels are challenging to manage. We examined the impact of automated insulin delivery (AID) versus multiple daily injections (MDI) plus continuous glucose monitoring (CGM) on inpatient glycemic control stratified by baseline A1c. Methods: In this inpatient randomized controlled trial, adults with type 1 or type 2 diabetes were assigned to AID or to continue MDI. Both groups received real-time CGM. Primary Endpoint: time in range (70-180 mg/dl) stratified by A1c. Key secondary endpoints: mean glucose, time above range (TAR250 mg/dl), mean glucose, and time below range (TBR 70 mg/dl). Results: A total 130 participants with diabetes were randomized to AID vs CGM. Stratified analyses by baseline glycated hemoglobin A1c demonstrated consistent superiority of AID compared with MDI+CGM. Time in range was higher with AID across all A1c categories (7.5%: 67 ± 17 vs 49 ± 27; 7.5-8.9%: 66 ± 18 vs 47 ± 20; 9.0-10.9%: 74 ± 14 vs 32 ± 17; ≥11%: 67 ± 14 vs 32 ± 17; all p 0.05). Mean glucose and TAR (180) were lower in the AID group compared with control (all p 0.05; Figure), with no difference in time below range between groups. Conclusion: In hospitalized patients with diabetes, AID was associated with improved glycemic outcomes compared with MDI+CGM across all hemoglobin A1c categories. Disclosure R. Parab: None. G. Davis: Research Support; Current; Insulet Corporation, Sequel Med Tech. 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. S. Brown: Research Support; Current; Insulet Corporation, Tandem Diabetes Care, Inc., Dexcom, Inc. Research Support; Ended; Roche Diabetes Care, Tolerion, Inc. S. Usman: None. 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. J.M. Feeley: Research Support; Current; Dexcom, Inc. M. Stumpf: None. K. Miller: None. J.C. Costin: None. N. Reyes: None. Z. Wen: None. M.C. Sanchez Valenzuela: None. C. Alix: None. L. Chadalawada: None. M. Weber: None. T. Idrees: Research Support; Current; AbbVie Inc. R.S. Kingman: None. B. Suh: None. Y. Liu: None. M. Morgan: 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. 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.
PARAB et al. (Fri,) studied this question.
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