Six-month real-world glycemic improvement after Smart MDI system in type 1 diabetes.
4 affiliations
- 1International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università degli Studi di Milano, 20157 Milan, Italy.
- 2Division of Endocrinology, ASST Fatebenefratelli Sacco, 20157 Milan, Italy.
- 3Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, 02115 MA, USA.
- 4Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, 02115 MA, USA.
Abstract
Smart multiple daily injection (Smart MDI) system integrating continuous glucose monitoring (CGM), insulin pens, and decision-support tools may optimize glycemic control in type 1 diabetes (T1D). However, real-world data remain limited. We evaluated 6-month glycemic outcomes following transition to Smart MDI in adults with T1D and explored differences according to carbohydrate counting status. This retrospective, single-center, observational study included 24 adults with T1D on MDI who transitioned to Smart MDI. CGM metrics were analyzed at baseline and after 1, 3, and 6 months. The primary outcome was change in time in range (TIR 70-180 mg/dL). Secondary outcomes included time above range (TAR), time below range (TBR), mean glucose, glucose management indicator (GMI), coefficient of variation, and HbA1c. Exploratory analyses compared individuals practicing carbohydrate counting (n = 12) with those who did not (n = 12). TIR increased progressively from 56.1 ± 20.4% to 66.3 ± 17.5% (median change +9.0%, P < .01). TAR and TBR significantly decreased. HbA1c declined from 7.6 ± 1.1% to 7.3 ± 0.9% (median change -0.2%, P = .01). While between-group differences were not significant, individuals not practicing carbohydrate counting showed preliminary within-group improvements in TIR, TAR, mean glucose, GMI, and HbA1c, without increased TBR, whereas changes in the carbohydrate counting group were smaller. Transition to the Smart MDI system was associated with clinically meaningful improvements in CGM metrics and HbA1c over 6 months. Improvements among individuals not practicing carbohydrate counting suggest that the Smart MDI system may provide standardized decision support also beneficial in less structured self-management settings. Larger studies are warranted to confirm these findings.
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BibTeX
@article{rossi2026sixmonth,
title = {{Six-month real-world glycemic improvement after Smart MDI system in type 1 diabetes.}},
author = {Giada Rossi and Ida Pastore and Laura Montefusco and Lorenzo Pozzi Canova and Francesca D'Addio and Paolo Fiorina},
journal = {Journal of the Endocrine Society},
year = {2026},
month = oct,
doi = {10.1210/jendso/bvag244},
url = {https://europepmc.org/article/MED/42953063},
note = {CC BY},
}
RIS
TY - JOUR
TI - Six-month real-world glycemic improvement after Smart MDI system in type 1 diabetes.
AU - Giada Rossi
AU - Ida Pastore
AU - Laura Montefusco
AU - Lorenzo Pozzi Canova
AU - Francesca D'Addio
AU - Paolo Fiorina
PY - 2026
DA - 2026/10/28
JO - Journal of the Endocrine Society
DO - 10.1210/jendso/bvag244
UR - https://europepmc.org/article/MED/42953063
AB - Smart multiple daily injection (Smart MDI) system integrating continuous glucose monitoring (CGM), insulin pens, and decision-support tools may optimize glycemic control in type 1 diabetes (T1D). However, real-world data remain limited. We evaluated 6-month glycemic outcomes following transition to Smart MDI in adults with T1D and explored differences according to carbohydrate counting status. This retrospective, single-center, observational study included 24 adults with T1D on MDI who transitioned to Smart MDI. CGM metrics were analyzed at baseline and after 1, 3, and 6 months. The primary outcome was change in time in range (TIR 70-180 mg/dL). Secondary outcomes included time above range (TAR), time below range (TBR), mean glucose, glucose management indicator (GMI), coefficient of variation, and HbA1c. Exploratory analyses compared individuals practicing carbohydrate counting (n = 12) with those who did not (n = 12). TIR increased progressively from 56.1 ± 20.4% to 66.3 ± 17.5% (median change +9.0%, P < .01). TAR and TBR significantly decreased. HbA1c declined from 7.6 ± 1.1% to 7.3 ± 0.9% (median change -0.2%, P = .01). While between-group differences were not significant, individuals not practicing carbohydrate counting showed preliminary within-group improvements in TIR, TAR, mean glucose, GMI, and HbA1c, without increased TBR, whereas changes in the carbohydrate counting group were smaller. Transition to the Smart MDI system was associated with clinically meaningful improvements in CGM metrics and HbA1c over 6 months. Improvements among individuals not practicing carbohydrate counting suggest that the Smart MDI system may provide standardized decision support also beneficial in less structured self-management settings. Larger studies are warranted to confirm these findings.
SN - 2472-1972
ER -