Real-World Implementation of Telemonitoring-Supported Care Redesign in Type 1 Diabetes: Reduced Outpatient Utilization with Preserved Glycemic Outcomes

Background: The widespread adoption of automated insulin delivery systems has created new opportunities for remote monitoring and data-driven redesign of diabetes care. However, real-world evidence on telemonitoring-supported care redesign remains limited. Methods: We conducted a real-world before–after study in 109 individuals with type 1 diabetes treated with the MiniMed™ 780G automated insulin delivery system. Routine care was redesigned from multiple annual outpatient visits to a default annual combined physician–diabetes specialist nurse visit supported by structured remote monitoring through CareLink™ Premium. Outcomes were assessed over two consecutive 12-month periods before and after implementation. Results: Telemonitoring-supported care redesign reduced outpatient utilization from 4.92 to 2.49 visits per patient-year, representing an approximate 50% reduction. Glycemic outcomes remained stable, with no clinically meaningful change in HbA1c (56.3 ± 1.0 vs. 56.2 ± 1.0 mmol/mol) and preserved Time in Range (74.6 ± 0.7 vs. 72.4 ± 1.0%). No safety signal was identified, with one diabetic ketoacidosis event observed during each study period and no increase in severe adverse events. Treatment satisfaction improved (median DTSQc score 11.5), while satisfaction with telemonitoring-supported care and digital messaging was high. Conclusions: Telemonitoring-supported care redesign enabled substantial reductions in outpatient utilization while maintaining glycemic control and participant satisfaction, with no safety signal identified. These findings support telemonitoring not merely as a clinical intervention but as an enabling infrastructure for organizational redesign of diabetes care.