Looking beyond glycaemic control: real‐world 12‐month cardiometabolic and retinopathy outcomes following Omnipod 5 initiation in people with type 1 diabetes

Aims

To evaluate the real-world effectiveness, safety, and tolerability of the Omnipod 5 hybrid closed-loop system in adults with type 1 diabetes (T1D) with a novel focus on cardiometabolic markers alongside diabetic eye disease and renal function.

Methods

A single-centre, retrospective analysis of adults with T1D using Omnipod 5 was conducted. Case notes were reviewed for routinely collected clinical data. Continuous glucose monitoring (CGM) metrics were obtained from cloud-based platforms at 3, 6 and 12 months. Paired data were analysed with two-tailed t-tests or Wilcoxon signed-rank, with results presented as mean (SD) or median (IQR).

Results

One hundred individuals were included (63% female). At baseline, median age was 28 (23.0–37.8) years, BMI 27.0 (22.3–30.0) kg/m2, diabetes duration 16.0 (9.0–24.8) years and mean HbA1c 68 (±18.0) mmol/mol. Over half (52%) transitioned from multiple daily injections. Significant glycaemic improvements were observed by 3 months. Improvements were durable to 12 months, with mean HbA1c falling from 68.5 to 58.8 mmol/mol (p < 0.001, n = 75) and time in range (TIR) increasing from 43.4% to 58.3% (p < 0.001, n = 86). The greatest glycaemic improvements were observed in those with lower TIR at baseline. Retinopathy progression occurred in a minority of 10 individuals, all of whom had a baseline HbA1c > 53 mmol/mol.

Conclusions

Initiation of Omnipod 5 was associated with durable glycaemic improvements. Preliminary data generate the hypothesis that retinopathy progression may be concentrated among individuals with baseline HbA1c above target range. Prospective studies are required to evaluate long-term retinal and cardiometabolic outcomes while controlling for concomitant weight and lipid-lowering therapies.