MON-604 Errors in Patient Self-Programming Settings in Automated Insulin Delviery Systems

Abstract Disclosure: A. Hanan: None. J.L. Snitzer: None. Introduction: Automated insulin delivery (AID) systems, such as Tandem Control-IQ, Medtronic 780G SmartGuard, and Omnipod Automated mode, have revolutionized diabetes management by providing real-time insulin adjustments based on continuous glucose monitoring (CGM) data. This report presents two distinct clinical cases that highlight the critical role of AID systems in managing diabetes mellitus (DM). Clinical Cases: The first case involves a 74-year-old male with Type 1 DM diagnosed in 1978, with complications including coronary artery disease, peripheral neuropathy, erectile dysfunction, and renal insufficiency. He maintained good glycemic control using a Tandem insulin pump and Dexcom CGM in Control-IQ mode despite not bolusing for food. However, after receiving a replacement pump, he failed to activate the Control-IQ feature, leading to significant deterioration of his glycemic metrics over two months. In September, with Control-IQ active 97% of the time, his average glucose was 187 mg/dL, time in range (TIR) 54%, standard deviation 88 mg/dL, glucose management indicator (GMI) 7.8%, and average daily insulin dose 37.56 units. By December, with Control-IQ inactive, his average glucose rose to 303 mg/dL, TIR dropped to 16%, standard deviation increased to 98 mg/dL, GMI rose to 10.6%, and his average daily insulin dose decreased to 25.16 units. The second case describes a 45-year-old male with Type 1 DM diagnosed in 1994, who had good diabetes control using a Medtronic 780G pump and Guardian 4 CGM. He inadvertently set his basal rate to zero but had the SmartGuard feature activated. Despite initial hyperglycemia with glucose levels in the 200-300 mg/dL range, the system was able to compensate, and after two weeks, it restored his glucose levels to his prior good control. Conclusion: These cases underscore the importance of AID systems in modern diabetes care. They demonstrate the importance of automation; the absence of Control-IQ in Case 1 revealed possible deficiencies in manual settings and lack of bolusing for food, leading to poor glycemic control. In Case 2, the Medtronic 780G SmartGuard worked well but if the patient went into manual mode, his BG’s would likely have been very high due to no basal rates. AID systems act as vital safety nets by reducing reliance on manual insulin adjustments and mitigating the impact of incorrect settings. Lastly, they highlight the critical need for patient education. Ensuring that patients understand how to turn on their AID function is essential, particularly when a pump is replaced. Overall, these findings emphasize the critical role of AID systems in enhancing glycemic control, mitigating human error, and improving the safety of diabetes management. They also highlight the need for comprehensive patient education, and periodic review with reassessment of pump settings to ensure optimal performance of these advanced technologies. Presentation: Monday, July 14, 2025