TOPLINE:

Automated insulin delivery (AID) systems lowered A1c levels and increased percentage of time in range in adults with type 2 diabetes (T2D), regardless of C‑peptide level, a secondary analysis of a clinical trial showed.

METHODOLOGY:

• The Centers for Medicare & Medicaid Services (CMS) requires a low C‑peptide level for insulin pump coverage unless a person is positive for beta‑cell autoantibodies; this rule prevents many patients with T2D from obtaining coverage for AID systems.
• Researchers performed a secondary analysis of a clinical trial in which adults with insulin-treated T2D were randomly assigned to either receive AID systems or continue their prior insulin delivery method with real‑time continuous glucose monitoring (control group).
• They categorized 254 patients who had a blood glucose concentration ≤ 225 mg/dL at the time of C‑peptide measurement and were negative for antiglutamic acid decarboxylase antibodies into high C‑peptide (n = 195) and low C‑peptide (n = 59) groups.
• Changes in A1c level and other glycemic parameters from baseline to 13 weeks were assessed for the high and low C-peptide subgroups.

TAKEAWAY:

• In the AID group, the mean A1c level decreased by 0.8% from baseline — a significantly greater reduction than in the control group for both the high (P < .001) and low (P = .02) C‑peptide subgroups.
• The AID group also had higher percentages of time in range (70-180 mg/dL) than the control group for both high (P < .001) and low (P = .009) C-peptide levels.
• Among patients aged 65 years or older, the use of AID systems led to greater reductions in A1c levels among those with high C‑peptide levels than among those in the control group (P = .01) but not among those with low C‑peptide levels (P = .32).

IN PRACTICE:

“A benefit of AID is present with high C-peptide levels and low C-peptide levels. Thus, requiring a low C-peptide level as a prerequisite for AID therapy is not warranted,” the authors wrote.

SOURCE:

The study was led by Irl B. Hirsch, University of Washington School of Medicine in Seattle. It was published online in Diabetes Care.

LIMITATIONS:

C-peptide levels were not necessarily measured in participants who were fasting. The number of participants in the low C-peptide subgroup was relatively small. The trial duration was limited to 13 weeks. 

DISCLOSURES:

The study received funding and AID systems from Tandem Diabetes Care. One author declared being an employee and shareholder of Tandem Diabetes Care. Other authors reported receiving grants and other payments from several pharmaceutical companies including the funding agency; these payments were made either to the authors or to their employers.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.