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Multicenter Study
. 2025 Jul;51(4):101654.
doi: 10.1016/j.diabet.2025.101654. Epub 2025 Apr 21.

Automated insulin delivery after beta-cell replacement failure in people living with type 1 diabetes

Quentin Perrier  1 , Sandrine Lablanche  2 , Luc Rakotoarisoa  3 , Orianne Villard  4 , Jean-Pierre Riveline  5 , Jean-Baptiste Julla  5 , Fanny Buron  6 , Sophie Reffet  7 , Eric Renard  4 , Laurence Kessler  3 , Pierre-Yves Benhamou  2 ; GRAGIL network
Collaborators, Affiliations
Free article
Multicenter Study

Automated insulin delivery after beta-cell replacement failure in people living with type 1 diabetes

Quentin Perrier et al. Diabetes Metab. 2025 Jul.
Free article

Abstract

Aims: Patients living with highly unstable type 1 diabetes (T1D) are eligible for beta-cell replacement (βCR) therapy (islet or pancreas transplantation). This study aimed to evaluate glycemic control in patients treated with automated insulin delivery (AID) following failed βCR therapy, defined as secondary graft failure or marginal function.

Material and methods: A national, multicenter, retrospective study was conducted with 23 patients who had βCR failure treated with AID for at least three months. The primary outcome was the proportion of patients achieving recommended glucose targets (time in 70-180mg/dl range [TIR] > 70 %, time below range [TBR] < 4 % and HbA1c < 7 %). Secondary outcomes included TIR, glycemia risk index (GRI), HbA1c, coefficient of variation (CV), body weight, insulin doses, severe hypoglycemia and AID discontinuation.

Results: The proportion of patients achieving recommended glucose targets under AID increased from 5.0 % to 57.1 % after 12 months. TIR increased from 54.2 ± 18.0 % to 75.5 ± 9.6 % after 12-month AID, while GRI decreased from 45.8 ± 22.2 % to 25.6 ± 10.3 %. HbA1c levels decreased from 7.5 ± 0.9 % to 7.0 ± 1.1 % after 12-month AID. CV, body weight and insulin doses did not change. All patients were free from severe hypoglycemia under AID, including those who had experienced severe hypoglycemia after βCR failure. No patient discontinued the AID.

Conclusions: This study highlights the effectiveness of AID in achieving glucose control targets and preventing severe hypoglycemia in patients with T1D following βCR failure. AID may serve as a valuable therapeutic option to improve glucose control when graft function declines.

Keywords: Automated insulin delivery; Beta cell replacement; Islet transplantation; Pancreas transplantation; Unstable diabetes.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: QP, LR, FB and SR had nothing to declare. SL has received speaker honoraria from Abbott, Eli Lilly and DinoTech and served on advisory board panels for Abbott, Insulet, Medtronic and Dexcom. OV has received speaker honoraria from Eli Lilly, Novo Nordisk and Sanofi. JPR is an advisory panel member for Sanofi, MSD, Eli Lilly, Novo Nordisk, AstraZeneca, Abbott, Dexcom, Alphadiab, Air Liquide, Healthcare and Medtronic; and has received research funding from and provided research support to Abbott, Air Liquide Healthcare, Sanofi and Novo Nordisk. JBJ has received speaker honoraria from Eli Lilly, Novo Nordisk and Sanofi, served on advisory board panels for Sanofi. ER declares consultant/speaker fees from A. Menarini Diagnostics, Abbott, Air Liquide SI, Astra-Zeneca, Becton-Dickinson, Boehringer-Ingelheim, Cellnovo, Dexcom Inc., Eli-Lilly, Hillo, Insulet Inc., Johnson & Johnson (Animas, LifeScan), Medtronic, Medirio, Novo-Nordisk, Roche, and Sanofi-Aventis and research support by Abbott, Dexcom Inc., Insulet Inc., Roche, and Tandem Diabetes Care. LK has received speaker honoraria from Abbott, Eli Lilly, Novo Nordisk, Astra Zeneka, Sanofi Vitalaire Medtronic, Elivie servered on advisory board panels for Abbott, Novo Nordisk and Medtronic. PYB has received speaker honoraria from Abbott, Eli Lilly, Novo Nordisk, served on advisory board panels for Abbott, Insulet, Eli Lilly, Novo Nordisk, and is chief medical officer for Diabeloop.

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