Summary: In a small pilot trial, starting automated insulin delivery soon after type 1 diabetes diagnosis in publicly insured, mostly minority youth was feasible and well accepted, with a numerically higher proportion reaching glucose targets than usual care, though the difference was not statistically significant in this small sample.
PICO Summary
| Element | Detail |
|---|---|
| Population | 19 publicly insured youth (aged 6–21) within 3 months of type 1 diabetes diagnosis, 89% from underrepresented racial or ethnic groups; pilot RCT, USA. |
| Intervention | Early access to the Tandem Control-IQ automated insulin delivery system (n=13). |
| Comparison | Usual care (n=6), randomised 2:1, over 6 months. |
| Outcome | More of the AID group reached the >70% time-in-range benchmark (50% vs 0% at 3 months; 37% vs 0% at 6 months), though this was not statistically significant. All caregivers and 69% of youth reported satisfaction, and 85% continued AID after the study. Focus groups were favourable. |
Early AID in underresourced youth
Pilot RCT · new-onset type 1 diabetes · 6 months
A higher proportion of the early-AID group reached the >70% time-in-range target than usual care (37% vs 0% at 6 months), but this small pilot was not powered for significance. The signal is feasibility and acceptability, not proven glycaemic benefit.
Expert Commentary
This is an important equity-focused pilot, and its value lies in feasibility and acceptability rather than in proving glycaemic benefit. Disparities in diabetes technology access are well documented, with publicly insured and minority youth far less likely to be offered pumps and automated delivery despite often having worse control, so testing whether AID can be started early and sustained in exactly this group addresses a real gap. The encouraging signals are that uptake worked, satisfaction was high, and most youth kept using the system after the study, which speaks to acceptability when access barriers are removed. The essential caveat is statistical: with only 19 participants this pilot was not powered to demonstrate glycaemic superiority, and the higher proportion reaching target, while promising, did not reach significance, so it must not be read as proof of effect. Can I use this with my patients? Yes, in clinical posture. It supports proactively offering technology and dedicated support to underserved families early after diagnosis rather than assuming they cannot manage it, while I await larger trials to quantify the glycaemic benefit that this study could only hint at.
References
Yen K, Belapurkar S, Puckett C, et al. Pilot study of early adoption of automated insulin delivery in underresourced youth. J Diabetes Res. 2025;2025:6886806. doi:10.1155/jdr/6886806