Automated insulin delivery may be ‘key first-line therapy’ for type 1 diabetes
Key takeaways:
- Children and adults with type 1 diabetes had reductions in HbA1c at 13 weeks of automated insulin delivery use.
- Time in range improved and time in hyperglycemia dropped in the automated insulin delivery group.
Patients with type 1 diabetes initiating automated insulin delivery had a significantly lower HbA1c at 13 weeks than those receiving multiple daily insulin injections, according to a presenter.
In the RADIANT randomized controlled trial, researchers assessed glycemic outcomes for children and adults transitioning from multiple daily insulin injections to automated insulin delivery. Researchers found similar HbA1c reductions and increases in time in range for both children and adults in the trial. The findings were presented at the International Conference on Advanced Technologies & Treatments for Diabetes.
“In most countries, the standard of care for type 1 diabetes remains multiple daily [insulin] injections,” Emma Wilmot, MB, ChB, BSc (hons), PhD, FRCP, clinical associate professor in diabetes and endocrinology, faculty of medicine and health sciences at University of Nottingham, consultant diabetologist at University Hospitals of Derby and Burton NHS in the U.K., and founder of the Diabetes Technology Network UK, said during a presentation. “Despite the addition of continuous glucose monitoring, we know that this is not enough to get people to a level of glycemia to prevent long-term complications. We also know that there is limited data available looking at those who transition from multiple daily injections to automated insulin delivery with suboptimal glycemia.”
Researchers enrolled 188 children and adults aged 4 to 70 years with type 1 diabetes for at least 1 year who were managing their diabetes with multiply daily insulin injections plus a CGM for at least 3 months before enrollment. The study group was recruited from 19 centers in the U.K., France and Belgium. Participants were randomly assigned, 2:1, to use the Omnipod 5 automated insulin delivery system (Insulet) or continue multiple daily injections for 14 days. Both groups used the FreeStyle Libre 2 CGM (Abbott Diabetes Care). As Healio previously reported, Omnipod 5 was originally cleared by the FDA for children and adults with type 1 diabetes in January 2022 and later received FDA clearance for adults with type 2 diabetes in August 2024.
HbA1c reductions at 13 weeks
Of the study group, 58% were children aged 4 to 17 years. There were 125 participants who used automated insulin delivery and 63 assigned to multiple daily injections plus a CGM.
Both groups had a mean HbA1c of 8.1% at baseline. At 13 weeks, the automated insulin delivery group had an HbA1c of 7.2% vs. an HbA1c of 8% for those receiving multiple daily injections (P < .0001).
Glycemic benefits were observed for both children and adults. Adults using automated insulin delivery had an HbA1c reduction from 8.3% at baseline to 7.3% at 13 weeks vs. an HbA1c decline from 8.2% at baseline to 8.1% at 13 weeks for adults receiving multiple daily injections (P < .0001). Among children aged 4 to 17 years, use of automated insulin delivery lowered HbA1c from 8% at baseline to 7.1% at 13 weeks, whereas those receiving multiple daily injections had an HbA1c reduction from 8.1% at baseline to 7.9% at 13 weeks.
Of 95 participants with a baseline HbA1c of 8% or higher, automated insulin delivery reduced mean HbA1c from 8.7% at baseline to 7.4% at 13 weeks, whereas the multiple daily injection group had an HbA1c decrease from 8.6% at baseline to 8.4% at 13 weeks (P < .0001).
Changes in CGM metrics
At 13 weeks, patients using automated insulin delivery had a time in range with glucose between 70 mg/dL and 180 mg/dL of 65% vs. a 43% time in range for the multiple daily injection group (P < .0001). The increase in time in range with automated insulin delivery was similar for adults and children.
The automated insulin delivery group had a time in hyperglycemia with glucose of more than 180 mg/dL of 32% at 13 weeks vs. 54% for the multiple daily injection cohort. Time in hypoglycemia with glucose less than 70 mg/dL was similar between the two groups at 2.56% with automated insulin delivery and 2.27% with multiple daily injections.
There were no reports of severe hypoglycemia or diabetic ketoacidosis in either group.
“These results solidify Omnipod 5 as a key first-line therapy for both adults and children with type 1 diabetes, regardless of their prior therapy,” Wilmot said.
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Wilmot EG, et al. Efficacy of the Omnipod 5 automated insulin delivery (AID) system compared with multiple daily injections in type 1 diabetes: A multinational randomized controlled trial (RADIANT). Presented at: International Conference on Advanced Technologies & Treatments for Diabetes; March 19-22, 2025; Amsterdam (hybrid meeting).