Automated Insulin Delivery in Type 1 Diabetes: Who Benefits Least and Why That Matters
DOI:
https://doi.org/10.5281/zenodo.22261606Keywords:
Automated insulin delivery, Closed-loop, Time in range, Health inequity, Type 1 diabetesAbstract
Automated insulin delivery improves glycaemic outcomes in type 1 diabetes, and meta-analysis puts the gain in time in target
range at roughly 8 to 12 percentage points. The average conceals a steep gradient. In a subgroup analysis of 168 trial participants
with baseline HbA1c from 5.4 to 10.6 per cent, those starting below 6.5 per cent recorded a 4.4 percentage point reduction in time
in range, while those above 8.5 per cent gained 21.9 points, rising to 30.4 points overnight. Benefit therefore scales with how poor
control was to begin with. The awkward consequence is that early trials recruited people below a maximum HbA1c threshold, on
established pump and sensor therapy, so the evidence was generated largely in the group that gains least. Where access was
universal, a real-world cohort of 160 adults, 26.9 per cent non-White and 48.8 per cent in the two most deprived quintiles, showed
no influence of ethnicity or deprivation on outcome.
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