Missed boluses may impact diabetes management and glycemic outcomes.A real-world analysis shows effective glycaemic control with the MiniMed 780G (MM780G) system—an advanced automated insulin delivery (AID) system with bolus autocorrection every 5 min—in users on no-bolus days, with more users achieving glycaemic goals when the recommended optimal settings (ROS) were used.
Data from consenting users in the global CareLink personal database with ≥10 days of MM780G system use (n=369,467) were retrospectively evaluated. Of these, 14.8 percent (n=54,553; 74.1 percent aged >15 years, 78.2 percent with type 1 diabetes [T1D]) did not administer boluses for ≥10 days.
Key metrics evaluated were time in range (TIR; 70–180 mg/dL), time below range (TBR; <70 mg/dL), time above range (TAR; >180 mg/dL), glucose management indicator (GMI), and total insulin delivered. ROS was defined as a 100-mg/dL glucose target and a 2-hr active insulin time. [Diabetes Care 2026;49:419-425]
The mean sensor glucose (SG) was 157.2 mg/dL. The mean TIR and time in tight range (TITR; 70–140 mg/dL) were 70.9 percent and 44.4 percent, respectively. The mean TAR and TBR values were as follows: TAR >180 mg/dL, 28.2 percent; TAR >250 mg/dL, 6.2 percent; TBR <70 mg/dL, 0.9 percent; and TBR <54 mg/dL, 0.2 percent.
Compared with non-ROS users, ROS users had lower mean SG (149.2 vs 159.7 mg/dL; p<0.001) and CV* of SG (30 percent vs 31.5 percent; p<0.001). The latter had a higher total daily insulin dose (53.4 vs 44.8 units; p< 0.001) and auto-bolus insulin delivery (17.9 vs 14.4 units) than the former, implying that ROS enhances AID, the researchers noted.
ROS users also had higher TIR (76.3 percent vs 69.3 percent) and TITR (49.6 percent vs 42.8 percent) and slightly lower TBR <70 mg/dL (0.8 percent vs 0.9 percent) and TBR <54 mg/dL (0.1 percent vs 0.2 percent; p<0.001 for all) than non-ROS users.
Moreover, ROS users were more likely to achieve ADA**-recommended glycaemic targets: 64.1 percent achieved GMI <7 percent, 71.2 percent achieved TIR >70 percent, and 98.6 percent maintained TBR <70 mg/dL <4 percent. Approximately two-thirds (61.5 percent) of ROS users met all three criteria.
“These findings highlight the importance of ROS in optimizing AID, reducing glycaemic variability, and simplifying diabetes management,” the researchers noted.
More type 2 diabetes (T2D) than T1D patients had no-bolus days (36.7 percent vs 13.4 percent). According to the researchers, the difference may have been driven by T2D patients’ higher reliance on basal insulin, which can minimize the need for frequent bolusing.
In the T1D subgroup, ROS users had higher TIR (74.9 percent vs 68.1 percent) and TITR (48.8 percent vs 42.1 percent) and lower TAR >180 mg/dL (24.2 percent vs 30.9 percent; p<0.001 for all) than non-ROS users.
A similar pattern was observed among T2D patients (TIR: 82.3 percent vs 76.7 percent, TITR: 53.5 percent vs 47.6 percent, and TAR >180 mg/dL: 17.5 percent vs 23 percent; p<0.001 for all).
Missed boluses and inconsistent bolusing behaviour can greatly affect diabetes management and glycaemic outcomes. [Diabetes Technol Ther 2024;26:897-907; Diabetes 2018;67:A259; Int J Diabetes Dev Ctries 2024;44:694-702]
“These findings highlight the capabilities of this advanced hybrid closed-loop system, which helped real-world users across diverse populations maintain glycaemic control on days when boluses were missed,” the investigators concluded.