Abstract
Introduction Automated insulin delivery systems have shown promise in bridging the gap between achieving international glycemic targets and the burden associated with achieving such outcomes. This is especially important in children and adolescents wherein addressing dysglycemia early can reduce long-term complications and mitigate cognitive impacts. This study presents the first real-world 3-year evaluation of the MiniMed™ 780G system in the global pediatric population, assessing long-term glycemic outcomes and user burden. Methods ‘Carelink Personal’ data from January 1,2020 to October 31,2025 were extracted from global MiniMed™ users aged ≤15 years with type 1 diabetes. Users had ≥10 days of sensor data before automation and in each of the 36 months post-advanced hybrid closed loop (AHCL) initiation. Endpoints were based on glycemic control, system use and insulin delivery type. User burden was defined as the percentage of insulin delivered by the user versus automatically by the system. Results Among 1,699 children, time in range (TIR 70-180 mg/dL) and time in tight range (TITR 70-140 mg/dL) increased immediately and remained elevated at 36 months (TIR increased from 64.1% to 73.6% at study end). TITR increased to 52.3% one month after SmartGuard™ initiation and experienced minimal changes throughout the study period. Time below range <70 mg/dL remained low, even as the proportion of insulin delivered automatically by the system increased. While the average grams of carbohydrates entered increased in growing children, the number of carb entries per day decreased. Time in automated mode remained consistently above 96%. From month 24 to 36 (the third year of use), TIR changed by +0.21 percentage points (P=0.1891) and GMI by +0.01 percentage points (P=0.1580). Conclusion In this three-year real-world analysis, glycemic improvements previously demonstrated following MiniMed™ 780G initiation were sustained through the third year of use, with consistently high automated mode use and an increasing proportion of insulin delivered automatically. The shift toward greater system-initiated insulin delivery suggests a reduction in burden for children and caregivers. These findings support the goal of automated insulin delivery systems, which is to improve glycemic control while minimizing daily management effort.