Early Use of Automated Insulin Delivery May Protect Against Diabetic Retinopathy Progression in Type 1 Diabetes: Study

Diabetic retinopathy is a common and potentially serious complication of diabetes, and concerns have been raised that rapid improvements in blood glucose control, particularly in individuals with longstanding diabetes, may lead to early worsening of diabetic retinopathy (EWDR). Since automated insulin delivery systems are known to bring about swift and significant improvements in glycemic control, it becomes essential to evaluate their safety in this context.

To address this concern, Matilda M.E. Johansson, Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand, and colleagues conducted a study to assess short-term outcomes of diabetic retinopathy in individuals aged 13 years and older with type 1 diabetes who had been using AID systems for a minimum of six months.

For this purpose, the researchers conducted a retrospective observational study across four centers, drawing participants from hospital databases in Dunedin and Christchurch, New Zealand, as well as from two research studies based in Auckland, New Zealand, and Perth, Australia. They gathered demographic and clinical information, along with diabetic retinopathy grading data before and after the initiation of AID, and performed statistical analyses to evaluate any changes in DR status over time.

The key findings of the study were as follows:

• Data from 165 individuals using three different automated insulin delivery (AID) systems were analyzed.
• The average reduction in HbA1c across the sample was 1.0 ± 1.3 percentage points.
• Diabetic retinopathy (DR) grading improved in 32 participants (19%).
• DR grading remained stable in 99 participants (60%).
• DR grading worsened in 34 participants (21%).
• The only significant risk factor for worsening DR was initiating AID at age 18 or older.
• Proliferative changes and the need for photocoagulation were observed in 3% of participants (5 out of 165).
• All individuals with proliferative changes had a history of DR, diabetes duration over 10 years, and at least one additional diabetes complication or prior DR treatment.

The study findings support the short-term retinal safety of automated insulin delivery (AID) systems in most individuals with type 1 diabetes, especially among younger users. The researchers reported that a majority of those who had recently begun using AID experienced either stable or improved diabetic retinopathy (DR) grades.

Highlighting a key insight, the researchers wrote, “Age at AID initiation under 18 years appears to offer a protective effect against the worsening of diabetic retinopathy.” Based on these observations, they concluded that early adoption of AID, before the onset of advanced age or multiple diabetes-related complications, may help preserve eye health and minimize the risk of DR progression in the short term.

Reference:

Johansson MME, March de Ribot F, Sime MJ, Boucsein A, Zhou Y, Jefferies CA, Paul RG, Wiltshire EJ, Abraham MB, Jones TW, de Bock MI, Wheeler BJ. Short-Term Diabetic Retinopathy Status in People with Type 1 Diabetes Commencing Automated Insulin Delivery. Diabetes Technol Ther. 2025 May;27(5):386-394. doi: 10.1089/dia.2024.0568. Epub 2025 Feb 10. PMID: 39925093.