Daily Carbohydrate Entries and Glycemic Outcomes following Automated Insulin Delivery System Initiation in Youth with Type 1 Diabetes: A Real-World Multinational Longitudinal Study

Objective: To assess the association between daily carbohydrate entries and glycemic outcomes in youth with type 1 diabetes after automated insulin delivery (AID) initiation in real-life settings.

Research Design and Methods: In this longitudinal, multinational observational study, 347 young individuals (7-21 years) with type 1 diabetes >1 year were followed for >6 months after AID initiation. Clinical data, including daily and overall continuous glucose monitoring-based time in range (70-180 mg/dL; TIR), time in tight range (70-140 mg/dL; TITR), and carbohydrate (CHO) entry metrics, were evaluated.

Results: Day-to-day variability in CHO entries was negatively associated with overall TIR (p<0.001) and TITR (p<0.001). Higher deviation in daily CHO entry was associated with lower daily TITR and TIR (both p<0.001). Overall TIR and TITR after AID initiation were 75.0% and 50.3%, respectively.

Conclusions: Variability in CHO entries is associated with lower TIR, emphasizing the importance of consistent pre-meal bolus routine when using AID.