1063-OR: ADA Presidents' Select Abstract: Automated Insulin Delivery in Hospitalized Patients with Diabetes and Advanced Kidney Disease

Introduction and Objective: Evidence to guide glycemic management in hospitalized patients with advanced kidney disease is limited. We compared automated insulin delivery (AID) with multiple daily injections (MDI) plus continuous glucose monitoring (CGM) on glycemic control in hospitalized adults with diabetes and advanced kidney disease. Methods: In this inpatient randomized controlled trial, adults with diabetes and an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m² were assigned to AID or to continue MDI. Both groups used real-time CGM. The primary endpoint was time in range (70-180 mg/dl). Secondary endpoints included mean glucose, time above range, and time below 70 mg/dl. Results: Twenty-seven participants with diabetes and advanced kidney disease were randomized to AID (n=14; age 61 years; BMI 32 kg/m²; A1c 7.1%) or MDI+CGM (n=13; age 59 years; BMI 29 kg/m²; A1c 6.2%). Time in range was 69±18% with AID vs 36±19% with MDI+ CGM (mean difference, 33%; 95% CI, 21-47, p<0.001; Figure) Mean glucose was lower with AID vs control (164± 25 vs 217 ± 36 mg/dL, p<0.001). Participants on AID spent 22% less time >250 mg/dL (95% CI, -34 to -9%). There was no difference in time <70 mg/dL or <54 mg/dL between groups. Conclusion: Among hospitalized patients with diabetes and eGFR <30 mL/min/1.73 m², AID was associated with higher time in the target range compared with MDI+CGM. Disclosure T. Akcan: None. R. Lal: Consultant; Current; Abbott Diabetes, Adaptyx Biosciences. Consultant; Ended; Biolinq, Capillary Biomedical, Deep Valley Labs. Consultant; Current; Gluroo, Portal Diabetes, Tidepool. Advisory Panel; Ended; ProventionBio, Lilly, Sanofi, Rezolute. S. Brown: Research Support; Current; Insulet Corporation, Tandem Diabetes Care, Inc., Dexcom, Inc. Research Support; Ended; Roche Diabetes Care, Tolerion, Inc. S. Usman: None. M.S. Hughes: Consultant; Current; Dexcom, Inc., Sanofi, Sequel Med Tech, LLC. M. Basina: None. J. Kirby: Stock/Shareholder; Current; PS Fertility. R. Parab: None. J.M. Feeley: Research Support; Current; Dexcom, Inc. M. Stumpf: None. K. Miller: None. J.C. Costin: None. N. Reyes: None. M.C. Sanchez Valenzuela: None. Z. Wen: None. C. Alix: None. L. Chadalawada: None. M. Weber: None. T. Idrees: Research Support; Current; AbbVie Inc. R.S. Kingman: None. B. Suh: None. M. Morgan: None. Y. Liu: None. M. Lee: None. M. Tan: Advisory Panel; Ended; Vertex Pharmaceuticals Incorporated. Consultant; Current; Novo Nordisk, Amylyx. K. Kingston: None. L. Peng: None. R.W. Beck: Research Support; Current; MannKind Corporation, Abbott Diabetes, Dexcom, Inc., Tandem Diabetes Care, Inc., Sequel Med Tech, DreaMed Diabetes, Ltd. Consultant; Ended; Novo Nordisk, Eli Lilly and Company. Consultant; Current; Zucara Therapeutics. G. Davis: Research Support; Current; Insulet Corporation, Sequel Med Tech. F.J. Pasquel: Research Support; Current; Dexcom, Inc., Insulet Corporation, Ideal Medical Technologies. Research Support; Ended; Novo Nordisk, Tandem Diabetes Care, Inc. Consultant; Ended; Insulet Corporation. Funding The National Institute of Diabetes and Digestive and Kidney Diseases (R01DK138366), with device support from Insulet and Dexcom, Inc.