Second-generation automated insulin delivery improved biochemical outcomes without reducing the psychological burden of type 1 diabetes. The study, published in Diabetes, Obesity and Metabolism, compared real-world treatment approaches using data from the Canadian BETTER registry.

The cross-sectional analysis included 1,731 adults with type 1 diabetes (mean age 45.3 ± 15.3 years; 69.2% female; mean diabetes duration 24.7 ± 16.0 years). Participants were categorized into 5 treatment groups: second-generation automated insulin delivery, first-generation automated insulin delivery, continuous glucose monitoring (CGM) + pump, CGM + multiple daily injections (MDI), and non-CGM regimens. Generalized linear models evaluated differences between second-generation automated insulin delivery and comparator groups.

Second-generation automated insulin delivery users had the highest proportion achieving haemoglobin A1c ≤7% (58.1%) compared with first-generation automated insulin delivery (40.6%), CGM + pump (40.5%), CGM + MDI (37.3%), and non-CGM approaches (32.3%) after adjustment (p<0.001). Treatment satisfaction was also higher in the second-generation automated insulin delivery group.

Despite improved glucose control, no differences were observed in person-reported outcomes or experiences. Elevated diabetes distress was reported by 55% of participants, and poor sleep quality by 63%, with similar prevalence across all treatment groups and even among those achieving optimal haemoglobin A1c.