February 10, 2026
3 min read
Key takeaways:
Most subgroups of adults with type 2 diabetes had HbA1c reductions at 13 weeks with automated insulin delivery.
The greatest decline was observed among those with a baseline HbA1c of 9% or higher.
Adults with type 2 diabetes who used an automated insulin delivery system had greater improvements in HbA1c than controls across multiple demographic and clinical characteristic subgroups, according to an analysis of the 2IQP trial.
As Healio previously reported, adults with type 2 diabetes receiving the Tandem t:slim X2 insulin pump with Control-IQ+ automated insulin delivery system had a mean decline in HbA1c from 8.2% at baseline to 7.3% at 13 weeks vs. an HbA1c decrease from 8.1% at baseline to 7.7% at 13 weeks for those continuing their usual insulin regimen. In a study published in Diabetes Technology & Therapeutics, researchers analyzed HbA1c change among different demographic groups to assess whether certain participants experienced greater glycemic improvements.
An automated insulin delivery system conferred HbA1c reductions across most subgroups of adults with type 2 diabetes. Image: Adobe Stock
“A benefit of the Control-IQ+ automated insulin delivery system was observed across a wide range of participant characteristics: age range 19 to 87 years, 39% [belonging to] a minority racial-ethnicity group, higher and lower socioeconomic status, high and low C-peptide levels, and shorter and longer durations of type 2 diabetes,” Roy W. Beck, MD, PhD, president and medical director of the Jaeb Center for Health Research Foundation in Tampa, Florida, told Healio. “In addition, very few of the participants had experience using an insulin pump, so the results show that being facile with use of diabetes technology is not a prerequisite for successful initiation of an automated insulin delivery system.”
Roy W. Beck
In the 2IQP trial, researchers enrolled 319 adults aged 18 years and older with type 2 diabetes receiving multiple daily insulin injections or insulin pump therapy. Participants were randomly assigned, 2:1, to use automated insulin delivery or continue their same insulin delivery method for 13 weeks. HbA1c change was the trial’s primary outcome.
HbA1c declines for most subgroups
Decreases in HbA1c were observed among most subgroups using automated insulin delivery. The only subgroups among those receiving automated insulin delivery that did not have at least a 0.5 percentage point drop in HbA1c at 13 weeks were adults with a baseline HbA1c of less than 7% (no HbA1c change) and those with a baseline time in range with glucose between 70 mg/dL and 180 mg/dL of more than 70% (mean HbA1c change, –0.3 percentage points).
The greatest difference in HbA1c change with automated insulin delivery vs. controls was observed among adults with baseline HbA1c of 9% or higher (mean change, –2.3% vs. –1%) and for adults with baseline time in range of 30% or less (mean change, –2% vs. –0.6%).
“There has been some thought that patients with very high HbA1c levels might not be good candidates [for automated insulin delivery] as there might be increased risk for severe hypoglycemia or diabetic ketoacidosis through misuse of the system,” Beck said. “Not only was there not increased risk, but those with the highest baseline HbA1c levels had the greatest amount of improvement.”
Among the automated insulin delivery group, 61% had the system active for at least 90% of the time during the 13-week trial, 16% used the system between 80% and less than 90% of the time and 14% used the system less than 80% of the time. HbA1c reductions were similar between the participants, regardless of how long the system was active.
More advances on the horizon
The findings show that all adults with insulin-treated type 2 diabetes can be considered for automated insulin delivery, and Beck said he believed that the results would likely be similar if the study was conducted using other systems.
“There will continue to be advances in automated insulin delivery technology,” Beck said. “The next big advance will be fully closed-loop systems that do not require user announcement of meals or correction doses. This should considerably reduce burden of using automated insulin delivery systems, particularly in type 2 diabetes.”
For more information:
Roy W. Beck, MD, PhD, can be reached at rbeck@jaeb.org.