1876-P: Automated Insulin Delivery Improves Glycemia in Hospitalized Patients with Type 1 Diabetes

Introduction and Objective: There are no randomized controlled data on inpatient glycemic management in patients with type 1 diabetes (T1D). We compared automated insulin delivery (AID) with multiple daily injections (MDI) plus continuous glucose monitoring (CGM) to assess glycemic control in the hospital setting. Methods: In this multicenter RCT, hospitalized adults with T1D were randomly assigned to AID or to continue MDI. Both groups used real-time CGM. Primary Endpoint: time in range (TIR, 70-180 mg/dl). Key secondary endpoints: mean glucose, time 250 mg/dl, and time 70 mg/dl. Results: Twenty-three participants with T1D (Age 45±15 years, A1c 8.9±3.5%) were randomized to AID (n=10) or MDI+CGM (n=13). AID resulted in significantly higher TIR (60.6±14.6% vs 40.7±15.0%; p=0.008), lower mean glucose (172±21 vs 207±33 mg/dL; p=0.011), and less time 250 mg/dL (8.4±9.9% vs 23.9±17.3%; p=0.019). Time spent below 70 mg/dL did not differ between groups (0.58±0.84% vs 0.62±0.88%; p=0.81). Differences in TIR by hour of the day and by day of enrollment are depicted in the figure. No episodes of DKA, HHS, or severe hypoglycemia occurred in either group. Conclusion: In hospitalized patients with T1D, AID improved glycemic control compared to MDI+CGM, significantly reducing hyperglycemia without increasing hypoglycemia, particularly overnight and persistently across hospital days. Disclosure M.S. Hughes: Consultant; Current; Dexcom, Inc., Sanofi, Sequel Med Tech, LLC. 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. T. Akcan: None. M. Basina: None. J. Kirby: Stock/Shareholder; Current; PS Fertility. R. Parab: None. J.M. Feeley: Research Support; Current; Dexcom, Inc. M. Stumpf: None. K. Miller: None. J.C. Costin: None. N. Reyes: None. M.C. Sanchez Valenzuela: None. Z. Wen: None. C. Alix: None. L. Chadalawada: None. M. Weber: None. T. Idrees: Research Support; Current; AbbVie Inc. R.S. Kingman: None. B. Suh: None. M. Morgan: None. Y. Liu: None. M. Lee: None. M. Tan: Advisory Panel; Ended; Vertex Pharmaceuticals Incorporated. Consultant; Current; Novo Nordisk, Amylyx. K. Kingston: 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. L. Peng: None. G. Davis: Research Support; Current; Insulet Corporation, Sequel Med Tech. 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.