Automated Insulin Delivery Reduces the Risk of Diabetic Retinopathy in Adults with Type 1 Diabetes: A Prospective Cohort Study

Aims: To evaluate the impact of automated insulin delivery (AID) systems on the incidence and progression of diabetic retinopathy (DR) in adults with type 1 diabetes (T1D) compared with multiple daily injections (MDI). Methods: This prospective cohort study followed 379 adults with T1D for a mean of 4.9 ± 1.4 years. DR was assessed via standardized retinal imaging. At baseline, 80 participants used AID, and 35 initiated AID during follow-up; 264 remained on MDI. Outcomes included baseline DR prevalence, incident DR, and DR progression. Multivariate Poisson and Cox regression models adjusted for key covariates (age, diabetes duration, pre-baseline HbA 1c ) were used, with propensity score-matched and HbA1c trajectory analyses as sensitivity checks. Results: DR prevalence at baseline was 13.9% with no group differences. Incident DR was lower among AID users (6.1% vs. 18.9% in MDI; hazard ratio = 0.33, 95% confidence interval: 0.13–0.73; P = 0.01; number needed to treat = 8). DR progression and all vision-threatening events occurred only in the MDI group (41.7% vs. 0%; P < 0.001). Use of AID systems resulted in a greater reduction in HbA 1c compared with MDI (−0.32% vs. −0.06%; P = 0.01). Conclusions: AID systems were associated with improved glycemic control and reduced incidence and progression of DR in adults with T1D. These findings support AID use to prevent early microvascular complications.