1888-P: Nearly 70% of Adults with Type 1 Diabetes Are Able to Achieve Recommended Glycemic Goals with Use of the Twiist Automated Insulin Delivery (AID) System: A Large Real-World Analysis

Introduction and Objective: The twiist™ AID System is the first FDA approved system with an algorithm based on Loop, which was developed by the Do-It-Yourself community and offers advanced algorithmic flexibility to support individualized therapy. This study analyzed the efficacy of the twiist AID System over a 7-month observation period in people with type 1 diabetes. Methods: From April 29 to December 8, 2025 there were 1,074 active twiist users encompassing 60,641 user-days. The CGM and insulin pump data were obtained from device cloud logs and retrospectively analyzed. This study analyzed mean CGM-based metrics over a 7-month period of time, stratifying results by daytime (6am-12 am) vs overnight (12 am-6 am) and % of people meeting ADA recommended glycemic goals. Results: Overall mean TIR was 74.4% (overnight 79.6%) with time 54-<70 mg/dL at 2.7% and time <54mg/dL at 0.4% (overnight 2.7% and 0.4% respectively). TITR averaged 51.8% (overnight 58.4%). Among users, 68% (n=728) achieved TIR >70%, 74% (n=790) maintained time <70 mg/dL <4%, and 45% (n=480) met both targets. Overall mean glucose was 145.8 +/- 50.5 mg/dL with a CV of 0.34. GMI was 6.6%. Conclusion: This is the first real-world analysis of more than 1000 users using the twiist™ AID System. Users achieved high TIR with Time-Below-Range within recommended targets. 68% of participants achieved the ADA recommended TIR goal of >70%. Disclosure V. Shah: Advisory Panel; Current; Abbott Diabetes, Dexcom, Inc. Advisory Panel; Ended; Medtronic. Advisory Panel; Current; Novo Nordisk, Eli Lilly and Company. Consultant; Current; Insulet Corporation, T1D Exchange. Advisory Panel; Current; Sanofi, Tandem Diabetes Care, Inc. Consultant; Ended; DreaMed Diabetes, Ltd. G. Aleppo: Advisory Panel; Current; Medscape, Tandem Diabetes Care, Inc. Consultant; Current; Eli Lilly and Company, Dexcom, Inc., Insulet Corporation. Research Support; Current; AbbVie Inc., Bayer, Fractyl, Insulet Corporation, MannKind Corporation, Tandem Diabetes Care, Inc., Medtronic. K. Snow: Employee; Current; Sequel Medtech. J.D. Ruck: Employee; Current; Sequel Med Tech. J. Jacoby: None. J. Mitri: Employee; Current; Sequel.