ORF10-03 - Glycemic Control and Weight Changes with Automated Insulin Delivery Systems in Children and Adolescents with Type 1 Diabetes: A Single-Center Real-World Study

Background/Objectives
Automated insulin delivery (AID) systems represent a major advancement in type 1 diabetes management, especially in pediatrics. Real-world evidence comparing the two most commonly used AID systems in the pediatric population in the United States—the Tandem t: slim X2 with Control-IQ (Tandem C-IQ) and the Omnipod 5— remains limited. While weight gain during transition from multiple daily injections (MDI) to pump therapy is well established, families frequently ask whether one AID system is associated with more weight gain than another, highlighting the need to understand the clinical utility of these devices with respect to both glycemic control and weight outcomes.

Materials and Methods
In this single-center retrospective observational study, 109 children and adolescents with type 1 diabetes were evaluated—approximately half using the Tandem t: slim X2 with Control-IQ system and the other half using the Omnipod 5 pump. Glycemic control was assessed using hemoglobin A1c (HbA1c) and continuous glucose monitoring (CGM)-derived hypoglycemia percentage at baseline, 6 months, and 1 year. Additional outcomes included total daily insulin dose (TDD) and weight/BMI changes. Statistical comparisons were conducted across time points and between groups.

Results
Both groups showed improvements in glycemic control at 1 year, with HbA1c reductions. The mean decrease in Hba1c after 1 year was by 0.84% in Tandem T Slim users and 0.62% in Omnipod5 users [p=0.346]. Hypoglycemia percentage remained low and comparable between groups, with both groups having < 2% hypoglycemia after 1 year [p=0.143]. TDD of insulin increased in both groups from baseline to 1 year (increase by 0.06 vs 0.08 u/kg/day) with no significant differences between systems (p=0.691 )

Weight gain occurred over the study period as measured by BMI [kg/m2] but there were no significant differences in the degree of weight gain between the Tandem C-IQ and Omnipod 5 groups (+1.6 vs +1.21 , p=0.173).

Conclusions
AID therapy with Tandem Control-IQ or Omnipod 5 pump leads to sustainable improvements in glycemic control in youth with type 1 diabetes, with comparable efficacy between systems. Although total daily insulin increased over time, the degree of weight gain was similar between devices, suggesting that the choice of AID system does not need to be driven by concerns about differential weight gain. Further studies incorporating daily caloric intake, pubertal stage and activity levels are needed to better characterize weight trajectories in this population.