Diabetic Retinopathy Outcomes and Early Worsening of Diabetic Retinopathy in Adolescents and Young Adults With Type 1 Diabetes Following Rapid and Large Glycemic Improvements After Commencing Automated Insulin Delivery

BACKGROUND: Automated insulin delivery (AID) improves glycemia in people with type 1 diabetes (T1D). However, concern remains about early worsening of diabetic retinopathy (EWDR) following rapid and large glycemic improvements. This study evaluated diabetic retinopathy (DR) outcomes in adolescents and young adults with T1D (aged 10-30 years) following AID initiation. METHODS: This retrospective observational study included adolescents and young adults with T1D and hemoglobin A1c (HbA1c) ≥ 8.5% (69 mmol/mol) prior to AID initiation. Clinical data, continuous glucose monitoring (CGM) metrics, and retinopathy grading were collected from research and clinical databases before and after at least three months of AID initiation. Statistical analyses assessed outcomes. RESULTS: A total of 95 adolescents/young adults (mean age 17.8 years, diabetes duration 9.7 years, 54.7% female) with a baseline HbA1c of 10.3% (89.5 mmol/mol) were included. Mean HbA1c improved by 2.1 percentage points (22.6 mmol/mol) following AID initiation. Retinopathy remained stable or improved in 72/95 (75.8%), while 23/95 (24.2%) experienced EWDR inclusive of diabetic macular edema (DME). While no one required treatment for DME, proliferative DR requiring treatment developed in three participants (3.2%); all had preexisting retinopathy and ≥1 additional diabetes-related complication/risk factor. Logistic regression identified age >18 years and preexisting retinopathy at AID initiation as the only significant risk factors for EWDR. CONCLUSIONS: Automated insulin delivery is associated with substantial glycemic improvement in adolescents and young adults with T1D. Despite these large glycemic improvements, diabetic retinal disease remains stable or improves in most cases. Risk factors for deterioration include age >18 years and preexisting DR.