Effects on glycaemic control when changing insulin delivery system from a manual patch pump to an automated insulin delivery system

Introduction: The use of automated insulin delivery (AID) have been shown to have many benefits. 
Objectives: In a cohort of children and adolescents with variable glycaemic control and a current Omnipod patch pump, the purpose of this study was to evaluate glycaemic effects after switching to Omnipod5 as AID.
Methods: From January to April 2025 children and adolescents at Steno Diabetes Center Copenhagen using Omnipod Dash or Eros was offered to change to the newest Omnipod5. Glycaemic variables as time in range (TIR), time in tight range (TITR), time below range (TBR) and time above range (TAR) was evaluated in a 2-week period prior to Omnipod5 start and after 2 and 4 weeks. Paired T-test was used for statistics and a p-value < 0.05 was considered statistically significant.
Results: As 82 children and adolescents using Omnipod chose to change to the Omnipod5, 80 selected Dexcom G6 and 2 Libre2Plus. Mean Hba1c before the AID was 58 mmol/mol (7.5%) with only 37.8 % meeting a target HbA1c of 53 mmol/mol and 18.3 % of 48 mmol/mol. Mean TIR at baseline was 54.8% where
18.4% reached the target of 70% TIR. TIR increased to 66.1% after 2 weeks and 66.5% after 4 weeks (p< 0.0001) as shown in figure, where 38% reached the target of 70% TIR too. Accordingly, both TAR and TBR significantly decreased after both 2 and 4 weeks compared to baseline, with a slight decrease in insulin use the first 2 weeks although no change when comparing to 4 weeks after. None discontinued use of Omnipod5. 
Conclusions: A significant and clinically relevant positive effects on TIR, TAR and TBR is already visible within 2 weeks and sustained at 4 weeks after exchanging from a regular patch pump (Omnipod Dash or Eros) to an AID (Omnipod5). The increment of more than 10% in TIR was seen, even without change in insulin needs after 4 weeks. If these beneficial glycaemic results are maintained the long-term risk of complications are substantially reduced.