OBJECTIVES: To evaluate the impact of an advanced hybrid closed-loop system (AHCL), t:slim X2 with Control-IQ technology, vs. MDI on concomitant medication use and glycemic control in people with T2D.

METHODS: We evaluated changes in medication use and HbA1c following initiation of an AHCL vs. MDI using real-world data. Retrospective data from Veradigm Network EHR linked to claims and Tandem data identified patients with T2D treated with either AHCL or MDI 1/15/20-12/31/20. Earliest treatment claim was index. Inclusion criteria required ≥12 months of continuous enrollment and EHR activity pre- and post-index. Non-insulin anti-diabetes medications and HbA1c were captured during the baseline and follow-up periods. Proportion of users who discontinued ≥1, exactly 1, or exactly 2 medication classes and change in HbA1c value from baseline to follow-up were evaluated.

RESULTS: A total of 414 AHCL and 108,856 MDI users were included. Most had non-insulin medication claims at baseline (55% AHCL and 70% MDI). Most common baseline medication was metformin (34% AHCL and 51% MDI). Baseline HbA1c was 9.1% for AHCL and 9.0% for MDI patients. There was greater reduction in proportion of patients with any non-insulin medication claims from baseline to follow-up in AHCL patients (-12%) compared to MDI (-0.4%) (p<0.001). A higher proportion of AHCL users discontinued ≥1 medication class (42%) compared to MDI (29%); 31% of AHCL patients discontinued metformin vs. 20% of MDI patients. HbA1c during follow-up was lower among AHCL users who discontinued ≥1 medication class (7.7%) vs. MDI (8.9%). AHCL users had a significantly greater decrease in HbA1c (-0.9%) vs. MDI users (-0.2%) (p<0.001).

CONCLUSIONS: Despite lower baseline medication use among AHCL patients, reductions from baseline to follow-up were greater compared to MDI patients. Patients with T2D newly initiating AHCL may benefit from reduced polypharmacy while maintaining benefits of lower HbA1c compared to continuing MDI therapy.