Automated insulin delivery beat standard insulin in Type 2 Diabetes

April 1, 2025

Apr 01, 2025

Summary: Traditionally, automated insulin delivery has been mostly limited to those with Type 1 diabetes. A new randomized trial supports offering this technology to those with Type 2 diabetes, which is far more common.

Source: Kudva, et al NEJM March 24, 2025

Automated insulin delivery systems (AID), where a continuous glucose monitor determines periodic dosing of insulin, have become increasingly common among those with Type 1 diabetes, where patients produce essentially no insulin and would die without insulin therapy. However, these systems are not as commonly used in those with Type 2 diabetes (T2D). T2D is over twenty times as common as Type 1, and often (although not always) affects those who are older and overweight or obese.

Researchers randomized 319 people with T2D who were getting insulin treatment to either have an AID or be maintained on their previous insulin therapy. This was a short trial (13 weeks) and demonstrated that AID was safe when used in T2D and led to lower hemoglobin A1C (HbA1C) levels, an indication of better diabetes control. Patients with AID also had blood sugar in the target range for longer, 64% of each day compared to 52% of each day for those without AID.

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Implications for employers:

● Members with poorly controlled T2D may be recommended to move to AID for their insulin administration.

● AID units cost can cost $6,000-$9,000, so would likely increase the cost of diabetes care.

● Better HbA1C control is associated with fewer complications of diabetes, such as kidney failure, blindness, and amputations.

● Other pharmaceutical agents for diabetes, including GLP-1s and another drug class SGLT-2s, are also effective, and should lead to fewer members needing insulin therapy in the future.

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