Diabetes-related acute care utilization following initiation of automated insulin delivery (AID): A comparison of a disposable tubeless AID system and durable tubed systems.

Abstract

Automated insulin delivery (AID) has quickly become a core pillar of standard of care for type 1 and insulin-requiring type 2 diabetes. Little evidence exists regarding rates of acute diabetes-related events requiring medical care and how they may differ across different AID systems. To assess whether new users of a disposable tubeless AID system experience different diabetes-related acute care needs compared with new users of durable tubed AID systems, which are largely reimbursed through durable medical equipment channels. In this retrospective cohort study of individuals with insulin-dependent diabetes in the Komodo Healthcare Map, individuals with preexisting use of continuous glucose monitoring were indexed on their first prescription fill for an insulin delivery system and observed until censoring or study end to ascertain their diabetes-related emergency department (ED) visits and inpatient hospital admissions. Index dates spanned August 1, 2022, through August 1, 2024, and study observation ended May 31, 2025. Rates of care utilization were modeled using Poisson regression, supplemented by stabilized inverse probability of treatment weighting, to estimate incidence rate ratios (IRRs) and differences per 1,000 person-years. Supplemental analyses were stratified by diabetes type. Among initiators of AID systems (N = 223,515), initiation of disposable tubeless AID (n = 110,061) was associated with lower rates of diabetes-related ED visits (IRR = 0.956; 95% CI = 0.921-0.993; -11.4 events per 1,000 person-years) and inpatient hospital admissions (IRR = 0.930; 95% CI = 0.868-0.998; -3.6 events per 1,000 person-years) compared with those initiating other systems (n = 113,454). Disposable tubeless AID initiation was also associated with lower rates of both hyperglycemia- and hypoglycemia-related ED and inpatient care. Differences in inpatient hospital admissions were largely driven by individuals with type 2 diabetes. The largest observed differences between diabetes type subgroups were among those with type 2 diabetes, including a notable 29.8% lower rate of ED visits for hypoglycemia (IRR = 0.702; 95% CI = 0.603-0.816) among disposable tubeless AID initiators. Initiation of disposable tubeless AID was associated with lower rates of ED visits and inpatient hospital admissions, with the largest differences observed for hypoglycemia-related ED visits. Expanded access to disposable tubeless AID could reduce health care resource utilization, their potential corresponding costs of care, and the burden of acute diabetes-related events on patients living with insulin-requiring diabetes.