A 13-week trial of the twiist automated insulin delivery (AID) system reduces HbA1c and increases time-in-range (TIR) among adults with insulin-treated type 2 diabetes (T2D), as shown in a single-arm multicentre study.
“Use of the twiist AID system was safe and associated with substantially improved glycaemia,” said the authors. “Certain unique features of the twiist system may be considered desirable by patients and providers when choosing an AID system.”
At 13 weeks, mean HbA1c levels decreased from a baseline of 8.1 percent to 7.4 percent, a reduction of 0.7 percent (p<0.001). Patients with baseline HbA1c levels ≥ 9 percent had the greatest reduction (from 10.3 percent to 8.2 percent). [Diabetes Care 2026;doi:10.2337/dc26-1270]
The mean TIR (70-180 mg/dL) increased from 57 percent to 73 percent, a 16 percentage point increase (p<0.001). Mean glucose levels, the percentage of time above 180 mg/dL, and the percentage of time above 250 mg/dL all decreased significantly (p<0.001 for all).
No cases of severe hypoglycaemia were reported. One patient developed diabetic ketoacidosis.
Additionally, patients reported sleeping better and feeling more satisfied with twiist than with their previous insulin delivery methods (p<0.001 for both).
From CGM to twiist
Researchers assessed the effectiveness and safety of the twiist AID system in 307 adults aged 19-85 years with insulin-treated T2D. They first wore a continuous glucose monitoring (CGM) sensor to establish baseline glucose levels, then switched to twiist for 13 weeks.
The primary outcome was the change in HbA1c from baseline to 13 weeks, measured at a central laboratory. Secondary outcomes, based on CGM data, included TIR, mean sensor glucose, and the percentage of time spent in different glucose ranges.
Before screening, participants had used one of four insulin regimens for at least 13 weeks: basal-bolus injections, an open-loop pump, premixed insulin, or basal insulin alone. Participants already taking non-insulin glucose-lowering medications, such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or sodium-glucose co-transporter 2 (SGLT2) inhibitors, continued taking a stable dose throughout the study.
A substantial HbA1c reduction was observed when AID was added to pre-study use of a GLP-1 RA or an SGLT2 inhibitor.
Benefits beyond GLP-1 RA, SGLT2i
“Benefit was observed in both users and non-users of GLP-1 RAs and SGLT2 inhibitors, indicating that AID can further improve glycaemia beyond the beneficial effects of these drugs,” the researchers said.
However, they noted that the 13-week follow-up was too short to assess long-term cardiometabolic outcomes. The study also did not measure how long it took to train participants to use twiist.
The twist system is approved for people aged 6 years and older with type 1 diabetes, but not for those with T2D.