Despite lower haemoglobin A1c with second-generation automated insulin delivery systems, mental burden remains high for all adults with type 1 diabetes: A BETTER registry analysis

Abstract

Objective: We aim to compare second-generation automated insulin delivery systems (AIDs) with other treatment modalities regarding both glucose management outcomes and person-reported outcomes/experiences (PROs/PREs, measured by the Hypoglycemia Fear Survey, Hypoglycemic Confidence Scale, Hyperglycemia Avoidance Scale, Diabetes Distress Scale, Pittsburgh Sleep Quality Index, Well-being Scale, and treatment satisfaction) among adults with type 1 diabetes. Research design and methods: Cross-sectional analysis of the Canadian BETTER type 1 diabetes registry. Adult participants were divided into five groups: second-generation AIDs, first-generation AIDs, continuous glucose monitoring (CGM) + pump, CGM + multiple daily injections (MDI), and non-CGM using MDI or pump. Generalized linear models were used to assess differences between the second-generation AID group and each of the other groups, with p < 0.05 considered significant. Results: Among 1731 participants (69.2% females), mean age was 45.3 ± 15.3 years with 24.7 ± 16.0 years of diabetes. The second-generation AID group had the highest proportion of achieving target haemoglobin A1c ≤ 7% (58.1%) compared to 40.6% in the first-generation AID group, 40.5% in the Pump + CGM group, 37.3% in the MDI + CGM group, and 32.3% in the non-CGM group, even after adjustment for multiple imbalanced characteristics (p < 0.001). While second-generation AID users reported higher treatment satisfaction, no other differences in measures of PROs/PREs were found between second-generation AID and other groups. Elevated diabetes distress (55%) and poor sleep quality (63%) remained common across all treatment groups, and even among those who had reached the optimal HbA1c target (48% and 60%, respectively). Conclusions: In real-world settings, second-generation AIDs were associated with lower haemoglobin A1c and higher treatment satisfaction but not better PROs/PREs. Mental burden remained high despite the use of advanced diabetes technologies and optimal glucose management.