1859-P: Optimizing Outcomes with the Twiist Automated Insulin Delivery (AID) System: Real-World Insights on Correction Range and Max Basal Rate Settings

Introduction and Objective: twiist is an AID system with an algorithm based on Tidepool Loop, which was developed by the open-source community and offers advanced algorithmic flexibility to support individualized therapy. Two important parameters include the Correction Range (CR), which can be set from 87-180 mg/dL, and max basal rate. In this real-world analysis, we evaluated the association between CR and max basal rate with glycemic outcomes. Methods: We calculated max basal ratio (MBR) as a normalized ratio of the most recent max basal rate to the highest programmed basal rate. Users were grouped by CR (<100 mg/dL, 100-140 mg/dL) based on the midpoint of the CR that is used ≥75% of the time and the MBR (<7.5, ≥7.5) most recently used. Glycemic metrics were compared across groups Results: Among 774 users, most (79%, n=610) used CR 100-140 mg/dL and MBR <7.5, while smaller subgroups used more aggressive targets. The highest TIR was observed in CR <100 mg/dL & MBR <7.5 (n=61, TIR 82.8%, time <54 mg/dL 0.6%). Users with CR 100-140 mg/dL & MBR <7.5 (n=610) achieved lower TIR (72.1%) but the lowest hypoglycemia (time <54 mg/dL 0.4%). Table 1. Conclusion: While most twiist users employed standard settings, those who adopted more aggressive settings achieved greater TIR and Time in Tight Range. twiist’s flexibility to allow a low correction range and optimized basal modulation supports personalization of glycemic control. Disclosure J. Mitri: Employee; Current; Sequel. 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. 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. J. Jacoby: None. K. Snow: Employee; Current; Sequel Medtech.