Volume 51, Issue 6, November 2025, 101703Author links open overlay panel, , , , , , , , Highlights•

Remission of diabetic retinopathy is associated with treatment using MiniMed 780G automated insulin delivery system in this prospective controlled study.

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This improvement was not observed in the group treated with multiple daily insulin injections and intermittent glucose sensors.

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Diabetic retinopathy remission is linked to improved glycemic control, as measured by HbA1c and glucometric parameters.

AbstractAims

Diabetic retinopathy (DR) is a complication of chronic hyperglycemia in people living with type 1 diabetes (PLWT1D). The use of automated insulin delivery (AID) systems may modify this course. In this prospective observational study, we evaluated whether the MiniMed 780G AID system was associated with remission or improvement in the severity of DR.

Methods

The study included PLWT1D with DR treated either with the AID system or with multiple daily insulin injections (MDI) combined with intermittent glucose monitoring. The follow-up period was two years. DR was graded annually, and HbA1c levels were recorded. Glucose monitoring parameters were also assessed to evaluate the impact of glucose ranges and variability on retinopathy. Group comparisons were performed using univariate and multivariate statistical analyses.

Results

DR remission occurred in 15/30 (50 %) participants treated with the AID system, compared with 0/30 (0 %) in the MDI group (P < 0.001). Improvement in DR stage was observed in 15/30 (50 %) participants in the AID group, compared with 2/30 (6.7 %) in the MDI group (P < 0.001). These outcomes were associated with lower HbA1c, reduced time above range (TAR), and a lower coefficient of variation (CV) in the remission group.

Conclusion

Remission or improvement of DR was observed in patients with type 1 diabetes treated with an AID system.

Introduction

Diabetic retinopathy (DR) remission has been reported following pancreas transplantation. Early insulin infusion systems from the 1980s did not demonstrate this outcome [1]. DR has long been considered an inevitable consequence of chronic hyperglycemia, and it remains the leading cause of blindness in working-age adults [2,3]. Studies comparing intensive versus conventional insulin therapy have shown a reduction in its development and progression [2,3].

Encouraging results have shown lower rates of DR development associated with the use of non-automated insulin infusion systems [[4], [5], [6]], independent of glycemic control. More recent evidence has supported the use of automated insulin delivery (AID) systems to improve the severity of DR [7], despite rapid reductions in HbA1c. This suggests that improvements in glucose monitoring parameters—particularly time in range (glucose levels between 70 and 180 mg/dl) and glycemic variability—may contribute to retinal protection. Higher parafoveal vascular density and increased central retinal thickness, both linked to DR protection [2], have also been reported in people living with type 1 diabetes (PLWT1D) using AID systems.

This study investigates DR remission in PLWT1D treated with AID systems, examining its potential association with glycemic control and glucose monitoring parameters.

Section snippetsMethods

This observational prospective study was approved by the institutional review board of La Paz University Hospital (HULP Code PI-6331). All participants provided written informed consent.

We consecutively enrolled patients diagnosed with diabetic DR who initiated treatment with the MiniMed 780G AID system between January 2021 and November 2023. Criteria for initiating AID therapy included HbA1c above 7.5 % despite intensive type 1 diabetes (T1D) management and/or frequent hypoglycemia. These

Statistical analysis

Differences between participants using AID systems and those receiving MDI therapy were evaluated using χ² tests for categorical variables and t-tests for continuous variables. All hypothesis tests were two-tailed. Multivariable logistic regression modeling was applied to assess associations between clinical and glycemic variables and the likelihood of DR remission or improvement, adjusting for potential confounders. A significance level of P < 0.05 was used for all analyses. All statistical

Results

A total of 30 patients with DR treated with the MiniMed 780G AID system were compared with 30 control subjects, matched for T1D duration, age, and DR stage. Among the AID group, 23 patients (76 %) had previously been treated with a non-automated insulin pump. The mean age was 48 years, and the mean duration of T1D was 38 years. Baseline characteristics and comorbidities are shown in Table 1. None of the participants received fenofibrate, which has been reported to reduce DR progression.

At

Discussion

This prospective study observed remission of mild NPDR in 50 % of patients with T1D treated with the MiniMed 780G AID system, compared with controls receiving MDI. Among the AID group, 38.5 % had previously been treated with a non-automated insulin pump. Patients in both groups were monitored using glucose monitoring devices, continuous in the AID group and intermittent in the MDI group. These findings were associated with improved glycemic control, as reflected by mean HbA1c, and glucose

CRediT authorship contribution statement

Beatriz Barquiel: Writing – review & editing, Writing – original draft, Visualization, Validation, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Daniel Álvarez: Writing – review & editing, Writing – original draft, Methodology, Investigation, Data curation, Conceptualization. Óscar Moreno Domínguez: Writing – review & editing, Methodology, Investigation. Elena García-Pérez de Sevilla: Writing – review & editing, Methodology, Investigation. Natalia Hillman:

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

We would like to express our sincere gratitude to Dr. Lucrecia Herranz De la Morena, whose commitment to education and passion for science have profoundly inspired our work.

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