O-27: Real-World glycemic outcomes with reduced BOLUS engagement in youth with type 1 diabetes using automated insulin delivery
J Cardin, F Niu, M Liu, C Yovanovich, V Chen, C Rodriguez, J Shin, R Vigersky, J McVeanAbstract
Introduction
Reduced engagement with meal bolusing is common among youth with T1D using automated insulin delivery (AID) systems and may adversely affect glycemia. Prior evidence indicates that algorithm-specific responses to bolus frequency should be considered by patients and caregivers during AID system selection.1
Objectives
This study aimed to evaluate real-world glycemic outcomes, time in automation, and insulin delivery in U.S. youth with T1D using the MiniMed™ 780G (MM780G) system with reduced user-initiated bolus frequency, assessing glycemic control in the setting of lower user engagement.
Methods
De-identified real-world ‘CareLink Personal’ data from U.S. MM780G users ≤22 years were analyzed between January and March 2026. Participants with self-reported type 1 diabetes, ≥14 days of CGM data, ≤3 user-initiated boluses per day, and non-missing gender and insulin dosing data were included. Glycemic outcomes included time in range (70–180 mg/dL), time below range (TBR), time above range (TAR), and insulin delivery characteristics. Outcomes were summarized for the overall cohort and a Recommended Optimal Settings (ROS, GT 100 mg/dL glucose target [GT]; active insulin time [AIT] 2 hours) subgroup.
Results
Among 917 participants, mean TIR was 58.8% overall and 63.7% among 320 participants in the ROS subgroup, while TBR remained low across groups (Table 1). Time in automation was high at 80-86%. Participants administered an average of two user-initiated boluses per day. Greater than 75% of total insulin was delivered by the system via basal and automated bolus.
Conclusions
In youth with reduced bolus engagement, the MM780G with ROS achieved a mean TIR over 60%, largely attributable to automated insulin delivery. These findings suggest that the algorithm can partially compensate for lower user-initiated bolusing and support consideration of the MiniMed™ 780G system in pediatric and young adult populations with inconsistent engagement.