Real-Life Performance of Automated Insulin Delivery Systems for High-Carbohydrate Meals: Are All Systems the Same?

Managing postprandial blood glucose levels in children and adolescents with type 1 diabetes remains challenging, particularly with high-carbohydrate meals. This study analyzed postprandial glycemic responses to Margherita pizza and a ham sandwich with similar macronutrient content in children using two different automated insulin delivery (AID) systems: MiniMed™ 780G and Tandem t:slim X2™ with Control-IQ. Thirty-four participants consumed both meals on separate occasions while maintaining standard insulin boluses. Results showed no significant differences in glycemic control between meals, suggesting that Margherita pizza can be effectively managed with standard bolus strategies. However, individuals using MiniMed 780G demonstrated a higher time in target range (70-140 mg/dL) in the 10 h following pizza consumption compared with Control-IQ users, possibly due to MiniMed 780G's multiple automatic correction boluses. No other significant differences in glucometrics or insulin delivery were observed. These findings highlight the need for personalized meal management strategies based on specific AID system algorithms. <b>Study registration:</b> ClinicalTrials.gov, NCT05729776.