Automated Insulin Delivery Use Among Preschool-Age Children With Type 1 Diabetes: A T1D Exchange Multicenter Analysis

Background: Use of automated insulin delivery (AID) systems has increased in people with type 1 diabetes (T1D); however, real-world data in preschool-age children remain limited. In this multicenter analysis, we assess real-world glycemic outcomes in preschool-age children using AID systems compared with those using multiple daily injections (MDIs). Methods: This retrospective, multicenter, cross-sectional analysis assessed current usage of AID systems and glycemic outcomes in preschool-age children ≤6 years across 37 pediatric sites in the T1D Exchange Quality Improvement Collaborative (T1DX-QI). Differences in AID use and HbA1c were evaluated using t tests and χ² tests, with multivariable logistic and linear regression models adjusting for age, race/ethnicity, diabetes duration and insurance type to assess associations between AID use and glycemic outcomes. Results: In this cohort of 3521 youth ≤6 years, the mean age was 4.6 (1.4), 47% female, 53% non-Hispanic white, 12% non-Hispanic black, and 14% Hispanic, and 31% with public insurance. Of these, 48% were using AID for insulin management with a mean HbA1c of 7.9% (1.7), compared with 52% using MDI with a mean HbA1c of 8.8% (2.2), P < .0001. In this cohort, 25% had an HbA1c <7%. AID use was associated with a greater odds of achieving HbA1c <7% (OR 1.91, 95% CI 1.57 to 2.33, P < .001). Conclusions: Real-world use of AID systems in preschool-age children (≤6 years of age) is associated with lower A1c levels and greater potential to achieve the American Diabetes Association (ADA) A1c target range of <7%.