Comparison between a tubeless, on-body automated insulin delivery system and a tubeless, on-body sensor-augmented pump in type 1 diabetes: a multicentre randomised controlled trial

Aims/hypothesis This study compares the efficacy and safety of a tubeless, on-body automated insulin delivery (AID) system with that of a tubeless, on-body sensor-augmented pump (SAP). Methods This multicentre, parallel-group, RCT was conducted at 13 tertiary medical centres in South Korea. Adults aged 19-69 years with type 1 diabetes who had HbA(1c) levels of <85.8 mmol/mol (<10.0%) were eligible. The participants were assigned at a 1:1 ratio to receive a tubeless, on-body AID system (intervention group) or a tubeless, on-body SAP (control group) for 12 weeks. Stratified block randomisation was conducted by an independent statistician. Blinding was not possible due to the nature of the intervention. The primary outcome was the percentage of time in range (TIR), blood glucose between 3.9 and 10.0 mmol/l, as measured by continuous glucose monitoring. ANCOVAs were conducted with baseline values and study centres as covariates. Results A total of 104 participants underwent randomisation, with 53 in the intervention group and 51 in the control group. The mean (+/- SD) age of the participants was 40 +/- 11 years. The mean (+/- SD) TIR increased from 62.1 +/- 17.1% at baseline to 71.5 +/- 10.7% over the 12 week trial period in the intervention group and from 64.7 +/- 17.0% to 66.9 +/- 15.0% in the control group (difference between the adjusted means: 6.5% [95% CI 3.6%, 9.4%], p<0.001). Time below range, time above range, CV and mean glucose levels were also significantly better in the intervention group compared with the control group. HbA(1c) decreased from 50.9 +/- 9.9 mmol/mol (6.8 +/- 0.9%) at baseline to 45.9 +/- 7.4 mmol/mol (6.4 +/- 0.7%) after 12 weeks in the intervention group and from 48.7 +/- 9.1 mmol/mol (6.6 +/- 0.8%) to 45.7 +/- 7.5 mmol/mol (6.3 +/- 0.7%) in the control group (difference between the adjusted means: -0.7 mmol/mol [95% CI -2.0, 0.8 mmol/mol] (-0.1% [95% CI -0.2%, 0.1%]), p=0.366). No diabetic ketoacidosis or severe hypoglycaemia events occurred in either group. Conclusions/interpretation The use of a tubeless, on-body AID system was safe and associated with superior glycaemic profiles, including TIR, time below range, time above range and CV, than the use of a tubeless, on-body SAP.