Early Initiation of Automated Insulin Delivery at Type 1 Diabetes Diagnosis in Children and Adolescents Is Associated with Improved Outcomes

INTRODUCTION: This retrospective cohort study evaluates the impact of timing of automated insulin delivery (AID) initiation on glycemic outcomes in youth with type 1 diabetes. METHODS: Data from 9856 children and adolescents diagnosed with type 1 diabetes between 2020 and 2022 across 27 U.S. centers were analyzed. Participants were grouped by AID initiation timing in months: <6, 6-12, 13-24, or no AID use. Hemoglobin A1c (HbA1c) trajectories, diabetes-associated ketoacidosis (DKA), and severe hypoglycemia rates were assessed over 24 months after T1D diagnosis. RESULTS: < 0.001). DKA rates were threefold higher in non-AID users. Adjusted models confirmed the timing of AID initiation independently predicted HbA1c outcomes. CONCLUSIONS: Early AID initiation is associated with improved glycemic control and reduced DKA risk, underscoring the importance of timely and equitable access to AID systems.