What Makes the Difference? Predicting Glycemic Trajectories Following Initiation of Automated Insulin Delivery Systems in Youth With Type 1 Diabetes
Authors' conclusion
Distinct glycemic trajectories exist following AID initiation, with all groups experiencing rapid early improvements in TIR and HbA1c that plateau or decline over time. Baseline bolus frequency and insulin doses/kg remain key predictors, highlighting the persistent influence of preexisting behaviors and insulin needs on long-term outcomes.
Study context
- Population
- Youth (ages 6–18) with T1D initiating automated insulin delivery (AID)
- Participants
- 713 participants
- Exposure
- Predictors of glycemic trajectory group membership after AID initiation
- Outcome
- Glycemic trajectories for TIR and HbA1c and associated factors
- Follow-up
- Baseline and 3, 6, 12, and 18 months of AID use
Methodological detailsgroup-based trajectory modeling, multinomial logistic regression
- Group-based trajectory modeling
- Multinomial logistic regression
Main finding
As reported in the abstract
Glycemic trajectories
Achieved time in range (TIR) ≥70% (group 4)
12.7%
Reached hemoglobin A1c (HbA1c) <7%
43.3%
Observational data: associations, not effects.
Further findings
Predictors of membership in lowest TIR group (group 1) vs highest (group 4)
| OR (95% CI) | ||
|---|---|---|
| Fewer user-initiated boluses | 2.46 (1.78–3.39) | |
| Higher insulin doses/kg | 1.54 (1.25–1.91) | |
| Fewer appointments | 2.69 (1.21–6.00) | |
| 0.20.5125Odds ratio (log scale) |
- Predictors of membership in lowest TIR group (group 1) vs highest (group 4): adjusted for age, sex, T1D duration, and prior treatment
Predictors of HbA1c trajectory
- Lower baseline insulin doses/kg and more boluses were associated with membership in the most optimal group
Original publication
What Makes the Difference? Predicting Glycemic Trajectories Following Initiation of Automated Insulin Delivery Systems in Youth With Type 1 Diabetes. Diabetes Care. Published 16 July 2026. doi:10.
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