The AID system demonstrated improvements in glycemic control parameters compared to CGM + MDI therapy. These findings align with ISPAD 2024 recommendations for early post-diagnosis glycemic management and support the potential benefits of early AID use [5]. No severe hypoglycemia or DKA events were observed during follow-up.

Tornese et al. investigated the safety of the Minimed™ 780G system in children under the age of 7 years [14]. Researchers have reported initiating the system within 2 months of diabetes onset, with a median diabetes duration of 49 days. Consistent with that study, our findings also demonstrated that early use of the AID system led to an increase in TIR and a reduction in HbA1c levels. However, the initiation time of the AID system in the study by Tornese et al. was longer than in our study [14]. In our study, the AID system was initiated at a mean of 3.33 ± 7.73 days after diagnosis, demonstrating its efficacy and safety in younger age groups. These findings confirm the positive impact of early initiation of the AID system on glycemic control, supporting our study results.

In a study conducted by Boughton et al., the CamAPS FX HCL system was initiated approximately 21 days after diagnosis in adolescents who were newly diagnosed with T1D. At month 12, HbA1c levels were 0.4% lower in the closed-loop group than in the standard insulin therapy group (6.9 ± 0.7 vs. 7.3 ± 1.1), and the TIR was higher (64% vs. 54%) [15]. At month 48, the TIR remained higher in the closed-loop group than in the control group (61% vs. 50%) [17]. In our study, the AID group showed a significant improvement in HbA1c levels and an increase in TIR values by month 12 compared to baseline. These findings are consistent with those reported by Boughton et al. and support the beneficial effects of early AID system use on glycemic control. Our 12-month HbA1c and TIR results were also better than those reported in that study, supporting the strength of our findings.

McVean et al. evaluated the effect of intensive glycemic management in newly diagnosed children aged 7–17 years with T1D using the tandem t:slim X2 insulin pump or the Medtronic™ 670G system, which was initiated 24 days after diagnosis. In the intensive care group, HbA1c levels decreased to 6.5% at week 52, while TIR was 78%, showing significant improvement compared with the standard care group (7.1% and 64%, respectively) [16]. In our study, the Minimed™ 780G AID system was initiated much earlier, resulting in greater improvements in both HbA1c levels and TIR at 12 months. In addition, it should be noted that the McVean et al. study included participants aged 7–17 years, whereas our cohort was younger. These differences in age may partly explain the outcomes, although our findings still suggest that earlier initiation of AID systems can improve glycemic control. Patton et al. also demonstrated the benefits of early initiation of insulin pumps or CGM in newly diagnosed children with T1D, noting significant reductions in HbA1c levels and improved glycemic control in children aged 5–9 years [18]. Additionally, continuous improvements in glycemic parameters, such as HbA1c, TIR, and TAR, were observed for up to 12 months in our AID group, consistent with the existing literature highlighting the long-term advantages and increased efficacy of HCL system use over time [19, 20]. The earlier start of the AID system in our study suggests that rapid adaptation enhances glycemic outcomes.

The difference in the timing of technology initiation between groups is a noteworthy observation. While the AID system was initiated within the first days after diagnosis, CGM use in the CGM + MDI group was introduced later. Possible reasons for earlier initiation in the AID group include (i) stronger encouragement and guidance from healthcare professionals, (ii) the greater likelihood of recommending AID in younger children, and (iii) family motivation. Families experiencing heightened anxiety at diagnosis may be more willing to adopt AID, and clinician guidance can accelerate this process. Younger age and a history of severe hypoglycemia have been associated with increased recommendations for AID, whereas adolescents with suboptimal glycemic control but limited social support are less likely to receive such recommendations [21]. Similarly, parents of young children using HCL systems reported choosing this technology earlier for reasons of safety and reduced caregiving burden [22].

In addition, individuals in the CGM + MDI group were slightly older, and it is well recognized that glycemic management is particularly challenging in pubertal children and adolescents with T1D. Puberty is characterized by increased insulin resistance, higher insulin requirements, and greater glycemic variability, which can lead to deterioration in HbA1c despite intensive management. Furthermore, behavioral and psychosocial changes specific to adolescence further complicate treatment adherence and metabolic control. These well-documented challenges in pubertal diabetes management may therefore have contributed to the differences observed in the CGM + MDI group [23,24,25].

This study has several limitations. The retrospective design, non-random allocation, and small sample size—particularly in the AID group—introduce potential biases and limit the generalizability of the findings, especially with regard to safety. Baseline differences between groups and the absence of systematically collected sociodemographic data may also have influenced the results. The limited sample size reduced the statistical power; therefore, the reported p values should be interpreted with caution. Overall, the study should be regarded as exploratory. Nevertheless, it provides preliminary evidence on the feasibility and potential benefits of initiating AID therapy at diagnosis in children and adolescents. Larger prospective randomized studies with longer follow-up are warranted to confirm these findings and to further investigate potential sex- and gender-related differences in accordance with the SAGER guidelines.