Real-world evaluation of automated insulin delivery therapy in type 1 diabetes: A multicentre study across regional and metropolitan Queensland, Australia

Abstract

Background: Automated insulin delivery (AID) systems, which integrate continuous glucose monitoring (CGM) with automated insulin dosing, have emerged as a transformative therapy. However, real-world data on AID effectiveness, particularly in regional Australia, remain limited. Methods: We conducted a retrospective audit across three Australian hospital sites—Logan (metropolitan), Mackay and Townsville (regional)—to evaluate the impact of AID therapy in adults with Type 1 Diabetes Mellitus (T1DM). Data on demographics, comorbidities, CGM metrics and clinical outcomes were extracted from medical records and device platforms. The primary outcome was change in HbA1c and CGM time-in-range (TIR; 3.9–10 mmol/L) at follow-up. Follow-up data were recorded up to 12 months following AID commencement. Secondary outcomes included changes in body weight, glycaemic variability and predictors of HbA1c reduction. Results: The study consisted of 158 people living with T1DM who were initiated on AID. Following AID initiation, mean TIR improved from 53.4% (SD 21.1%) to 70.0% (SD 14.6%) (p < 0.0001), and time in hyperglycaemia (>13.9 mmol/L) declined from 18.7% (SD 19.4%) to 8.4% (SD 9.31%) (p < 0.0001). The mean HbA1c significantly decreased from 8.62% (SD 1.70) at baseline to 7.34% (SD 1.31) at follow-up across the entire study cohort (p < 0.0001), with 42.7% achieving <7% and 64.1% achieving <7.5% at follow-up. Multivariable regression identified higher baseline HbA1c (p < 0.0001) as a significant predictor of HbA1c reduction. Improvements were consistent across AID system types and geographical settings. Conclusions: AID therapy significantly improves glycaemic control in adults with T1DM in both regional and metropolitan Australia. Our findings support the real-world effectiveness of AID systems and highlight their potential to bridge care gaps across diverse settings.