Impact of Demographic Features on Glycemic Management With Tubeless Automated Insulin Delivery Systems in Youth With Type 1 Diabetes

OBJECTIVE Automated insulin delivery (AID) systems have been shown to improve glycemic time in range (TIR) and A1C; however, there are limited data on their use among historically marginalized groups, technology-naive individuals, and young children. This study evaluated whether certain patient features affect the influence of tubeless AID on glycemic metrics in youth with type 1 diabetes. RESEARCH DESIGN AND METHODS This was a retrospective chart review involving patients 2–26 years of age with type 1 diabetes who were prescribed a tubeless AID system between January 2021 and May 2023. Demographic and diabetes treatment data were abstracted from the electronic medical record system. Cluster analysis methodology was used to identify clinically relevant patient groups based on demographics and medical history. Generalized mixed-effects modeling was used to compare TIR and A1C between groups. RESULTS Through review of cluster-identified patient characteristics, 133 participants were assigned to one of four groups. Group 1 ( n = 42) was predominantly White and privately insured, group 2 ( n = 26) had public insurance or was uninsured and was largely non-White, group 3 ( n = 44) had the lowest prior pump usage, and group 4 ( n = 21) had the youngest median age at diagnosis and at pump initiation. All groups had an increase in TIR and a decrease in A1C after pump initiation, and there was no difference in the improvement between groups (TIR from 46–47 to 60%, P <0.001 for all groups, and A1C from 8.41–8.44 to 7.45–7.49%, P <0.05 for all groups). CONCLUSION Improvements in glycemic management were consistent across groups, despite intragroup differences historically associated with barriers to diabetes management. These findings suggest the importance and potential impact of offering tubeless AID in mitigating care disparities and support its implementation for all youth with type 1 diabetes.