The Importance of Instigating Automated Insulin Delivery Systems at Onset of Type 1 Diabetes: 1-Year Follow-Up of Children and Adolescents from Two Tertiary Pediatric Diabetes Centers

: To evaluate differences in glucometrics in children and adolescents assigned to automated insulin delivery (AID), predictive low-glucose suspend (PLGS), or multiple daily injections (MDI) in the first month of diabetes management. In this real-world prospective cohort study, all subjects aged 0-18 years with diabetes onset between January 1, 2020, and June 30, 2023, were assigned to MDI (n = 24), PLGS (n = 28), or AID (n = 32) but were allowed to switch after the first 3 months. The primary outcome was HbA1c after 12 months. The mean age (n = 84) was 7.9 ± 3.9 years (range 1-18 years), and 58 were male. After 12 months, HbA1c was significantly lower in the AID group than in the PLGS or MDI groups (AID 6.6% ± 0.6% vs. PLGS 7.4% ± 1.1% vs. MDI 7.6% ± 1.5%, P = 0.001), with better time in range (P = 0.001), time below range (P = 0.01), time above range (P = 0.001), coefficient of variation (P = 0.01), and glucose management indicator (P = 0.001). AID is best started at diabetes onset to optimize glucose control outcomes.