AID Systems Need Upgrades for Premenopausal Glucose Control

Insulin requirements fluctuated significantly throughout the menstrual cycle without a consistent pattern, prompting a substantial proportion of premenopausal women with type 1 diabetes (T1D) to manually adjust their automated insulin delivery (AID) system settings to achieve better glycemic control.

METHODOLOGY:

• Although insulin requirements vary across phases of the menstrual cycle, understanding specific adjustments and strategies to manage cycle-induced changes in glucose control remains limited.
• Researchers conducted a combined quantitative and qualitative study to determine how often premenopausal women with T1D manually adjust their insulin delivery settings to offset hormonal fluctuations and maintain glucose control.
• They analyzed 354 menstrual cycles from data provided by 70 women with T1D using AID systems and complemented the quantitative results with qualitative insights from seven focus groups, including semi-structured interviews with 38 participants.

TAKEAWAY:

• A substantial proportion (43%) of women regularly adjusted their insulin delivery settings to counteract hormone-related fluctuations.
• Women who made insulin adjustments achieved a 5-percentage point greater time in range than those who did not adjust settings.
• To counteract menstrual cycle-induced glucose swings, women mainly tweaked their basal insulin rates, target glucose settings, and correction factors and — in some cases — resorted to ad hoc tactics like inputting fictitious carbohydrate amounts or deliberately underbolusing.

IN PRACTICE:

“Our findings highlight the limitations of current AID systems to fully automate glucose control for premenopausal women. As AID systems play an increasing role in diabetes care, it is crucial that they can appropriately adapt to factors affecting glucose levels,” the authors wrote.

SOURCE:

The study was led by Stefanie Hossmann, University of Bern in Switzerland. It was presented on June 23, 2025, at the American Diabetes Association 85th Scientific Sessions held at the McCormick Place Convention Center, Chicago (June 20-23, 2025).

LIMITATIONS:

No limitations were discussed in this abstract.

DISCLOSURES:

One author disclosed being an employee of Tidepool and serving on the Advisory Panel of Diabetes Center Berne. Another author reported being an employee of Abbott.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.