Abstract
Automated insulin delivery (AID) systems are the ‘gold-standard’ therapy for people with type-1 diabetes (T1D). However, research trials and clinical access for these therapies have historically lacked representation of non-European ethnicities, including Māori and Pacific Peoples. Until recently, these groups have been disproportionately disadvantaged by restrictive funding criteria. In a previous trial with 40% Māori and/or Pacific participants, we demonstrated that individuals with above-target glycated haemoglobin HbA1c were more likely to be socially disadvantaged, and derived significantly greater absolute glycaemic benefits. This study evaluates the efficacy and safety of AID use in Māori and Pacific adults (aged 16-65) with T1D and above-target glycaemia (HbA1c ≥64 mmol/mol).
At baseline, participants had a mean (±SD) age of 32.9±9.1 years, a mean HbA1c of 89.3±20.2 mmol/mol, and 91.7% used multiple daily injection therapy. Following 2-week baseline continuous glucose monitoring data collection, participants were trained on the AID system (MiniMed 780G insulin pump) using a 72-hour rapid onboarding protocol. Outcomes measured include HbA1c, time in glycaemic ranges, adverse events, and AID system performance.
After 6-weeks of AID, mean time-in-range 3.9-10.0 mmol/L and time-in-tight-range 3.9-7.8 mmol/L improved from 27.1±14.7% to 68.4±8.9%, and from 15.7±9.3% to 46.0%±9.5%, respectively. Time spent in hypoglycaemia <3.9 mmol/L decreased from 2.3±3.2% to 1.4±1.5%. There were no episodes of severe hypoglycaemia or diabetic ketoacidosis. A 9-month extension phase will assess long-term outcomes.
Māori and Pacific adults with above-target glycaemia using AID achieve substantial glycaemic control without an increase in time spent in hypoglycaemia, demonstrating that this high-priority population can successfully use this therapy. These findings highlight the need for equitable access to diabetes technology and provide crucial data to inform policy and future research in Aotearoa and globally.