Extended Use of Automated Insulin Delivery in Young People with Type 1 Diabetes and Elevated HbA1c: 52-Week Outcomes of the CO-PILOT Trial.

In 30 seconds

The CO-PILOT trial assessed 52-week outcomes of automated insulin delivery (AID) with MiniMed 780G in young people aged 7–25 years with type 1 diabetes and elevated baseline HbA1c. In this multicenter trial, 74 participants were initially randomized to AID or standard care for 13 weeks, followed by a continuation phase in which all used AID. In the AID-first group, mean HbA1c fell from 92 ± 20 mmol/mol at baseline to 67 ± 18 mmol/mol (8.3 ± 1.6%) at 52 weeks, with improvement stabilizing from 26 weeks in the whole sample.

Key findings

• At 13 weeks after starting AID, mean HbA1c decreased by -28 mmol/mol (95% CI: -33, -23) or -2.5 percentage points (95% CI: -3.0, -2.1).
• At 52 weeks, mean time in range in the AID-first group was 63.1 ± 13.7%, compared with 23.1 ± 13.4% at baseline among available participants.
• Compared with the 52 weeks before the trial, diabetic ketoacidosis rate decreased by a mean difference of -35.7 events per 100 participant-years; no severe hypoglycemia occurred.
• At 52 weeks, participants reported improved treatment satisfaction and reduced fear of hypoglycemia.

Why it matters

Young people with markedly elevated HbA1c may face substantial challenges achieving glycemic targets. These trial findings indicate that sustained use of this AID system was associated with durable improvements in HbA1c and time in range, alongside fewer diabetic ketoacidosis events and no severe hypoglycemia during the study. The psychosocial improvements also suggest that outcomes beyond glucose metrics may be relevant when evaluating AID in this population.

What to keep in mind

After the initial 13-week randomized comparison, all participants used AID, so longer-term outcomes lack a concurrent standard-care comparison. The 52-week HbA1c and time-in-range results are reported for the AID-first subgroup.