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Background Type 1 diabetes (T1D) is an autoimmune condition that affects 1 in 400 U.S. kids and teens, causing their bodies to no longer produce insulin and requiring lifelong insulin replacement therapy with injections or pumps to manage their blood sugar. Omnipod5 launched in 2022 as the first tubeless automated insulin delivery system. This pump integrates with the Dexcom G7 continuous glucose monitor and can be managed via a smartphone to adjust insulin delivery and manage glucose levels automatically. While Omnipod 5 has significantly improved glucose control, there are only modest A1c improvements for many patients. Our goal was to understand the drivers of glucose control based on measurable clinical, behavioral, or technological data. We investigated the relationship between insulin settings, patient behavior, and pump performance to identify the factors that influence time in range (TIR) (70-180 mg/dL). Methods All patients with T1D using the Omnipod 5 system at the Baylor College of Medicine pediatric endocrinology clinic in San Antonio were considered for this IRB-approved quality-improvement study. Approximately 400 patients were evaluated, and 59 were selected for inclusion in the study (22 males, 37 females, ages 4 to 19.4 years, mean 11.2 years). No specific exclusion criteria were applied. Data were obtained from the Glooko data management system. A multiple linear regression model was run with carb entries per day (1 to 6.8, mean 3) and percent time in automated mode (10% to 100%, mean 83%) against percent time in range (16% to 92%, mean 52%). Results For each additional carb entry per day, the TIR increases by 4.06% (p = 0.00094). For each additional 1% of time spent in automated mode, the TIR increases by 0.37% (p = 6.29e-06). Similarly, a 10% increase in time spent in automated mode is roughly equivalent to the impact of an additional carb entry (3.7% vs 4.06%). Both predictors are statistically significant and are positively associated with the TIR. The R-squared value was 0.5244. Conclusion Patients using Omnipod 5 may increase TIR and ultimately lower their blood glucose readings by increasing the amount of time in automated mode and increasing the number of carb entries per day, which justifies future interventional studies.
