Automated Insulin Delivery Significantly Lowered A1c for Patients With T2D
Among a diverse cohort of patients with type 2 diabetes (T2D), researchers examined the use of automated insulin delivery for lowering hemoglobin A1c levels.
Automated insulin delivery significantly lowered hemoglobin A1c (HbA1c) levels for patients with type 2 diabetes (T2D), according to data published in JAMA Network Open.1 The researchers’ findings led them to suggest automated insulin delivery as a safe and effective treatment option for patients with T2D using insulin.
“Diabetes is a major public health concern, affecting more than 38 million Americans, with high rates of morbidity and mortality. Despite the growing use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose transport protein 2 inhibitors (SGLT-2is), many individuals with T2D have hemoglobin A1c (HbA1c) levels greater than the target recommendations of the American Diabetes Association,” wrote the authors of the study.
The treatment of T2D has been difficult for providers despite a plethora of therapies accepted. | image credit: fovito / stock.adobe.com
For their growing use in treating obesity, diabetes, cardiovascular disease, and more, GLP-1 RAs have skyrocketed in demand. From 2019 to 2023, the number of prescriptions for these medications increased by 400%, with Medicaid alone spending $4.1 billion on GLP-1 RAs in 2022.2
However, lowering HbA1c levels remains a challenge both for patients and for providers. With GLP-1 RAs on the rise in recent history, as well as shifts in guidance for how to control HbA1c, the treatment of T2D has been difficult for providers despite a plethora of therapies accepted.
“After more than a decade of progress from 1999 to the early 2010s, glycemic and blood-pressure control declined in adult participants with diabetes, while lipid control leveled off,” wrote the authors of a study published in the New England Journal of Medicine.3
READ MORE: FDA Alerts of Potential Missed Safety Notifications With Smartphone–Compatible Diabetes Devices
Recent history has led researchers to explore more innovative options for treating HbA1c levels in patients with T2D. While the use of automated insulin delivery was demonstrated to improve glycemia in patients with type 1 diabetes, its exploration in patients with T2D has been limited to small trials containing minimal cohorts.
Researchers’ main goal was to examine the use of automated insulin delivery through patients’ changes in HbA1c from baseline to 13 weeks. Participants were observed from April 11, 2023, to February 29, 2024, and were aged 18 to 75. All patients had T2D, were using insulin for at least 3 months, and had never used an automated insulin delivery system.1 When the study began, the system used had only been cleared for patients with type 1 diabetes.
A total of 305 patients with T2D initiated automated insulin delivery (57% women; mean age, 57 years), and 289 of those participants completed follow-ups. The use of automated insulin delivery demonstrated a broad range of HbA1c reduction among the study population, with levels dropping from a mean of 8.2% to 7.4%. For individuals with a baseline HbA1c of 9% or higher, they saw the greatest reduction of 2.1%.
“In this trial, similar improvements in glycemic outcomes with AID [automated insulin delivery] were observed in users and nonusers of GLP-1 RA and SGLT-2i therapy, suggesting that adults with T2D who are taking stable doses of GLP-1 RA and SGLT-2i and require insulin therapy can benefit from AID,” they wrote.1
While the results of this study were not meant to undermine the efficacy of alternative options for lowering HbA1c, automated insulin delivery was highlighted as a supplemental therapy for patients using other medications but still failing to reduce HbA1c. As more research is conducted for the use of various therapies in treating T2D, automated insulin delivery may also require further investigation to solidify its use amongst HbA1c-lowering medications.
“During a single-arm nonrandomized trial in adults with T2D, glycemia improved over 13 weeks of AID use with no increase in hypoglycemia. Improvement in HbA1c levels was observed in participants using [multiple daily injections] and in those using basal insulin only at baseline, across diverse racial, ethnic, and socioeconomic backgrounds, and among individuals using noninsulin glucose-lowering medications, including GLP-1 RAs and SGLT-2is,” concluded the authors of the study.1
READ MORE: Diabetes Resource Center
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