Diabetes CareType 2 DiabetesRCTDecember 1, 2025

Additive Benefits of Control-IQ+ AID to GLP-1 Receptor Agonist Use in Adults With Type 2 Diabetes.

Graham TE, Raghinaru D, Afreen S, Ahmann A, Haidar A, Raskin P, Tsoukas MA, Lum JW, Sasson-Katchalski R, Pinsker JE, Beck RW, 2IQP Study Group*

View on PubMed DOI: 10.2337/dc25-1753

Key Finding

Adding automated insulin delivery to GLP-1 medications lowered HbA1c by an extra 0.5% compared to standard care, while preventing the typical 1.9 kg weight gain seen with insulin intensification.

What This Study Found

Think of diabetes management like driving a car - GLP-1 medications are like cruise control that helps maintain steady speed, while automated insulin delivery (AID) is like having an advanced AI co-pilot that constantly adjusts the steering wheel. This study tested what happens when you combine both systems in 143 adults with type 2 diabetes who were already using GLP-1 drugs like semaglutide or liraglutide. The results were impressive: people using the AI insulin system saw their HbA1c drop from 8.0% to 7.2% over 13 weeks - that's like going from a 'C+' to a 'B' grade in diabetes control. Most remarkably, this happened while people actually used less insulin overall, defying the usual trade-off where better blood sugar control means more insulin and weight gain. The weight story tells an important tale: people not on GLP-1 drugs gained nearly 2 kg (4.4 pounds) when they intensified their insulin therapy, but those on GLP-1 medications maintained stable weight despite dramatically better glucose control.

Statistics Decoded

HbA1c improvement of 0.5% (95% CI -0.8 to -0.3, P < 0.001): The automated system lowered long-term blood sugar by half a percentage point more than standard care - this wasn't due to chance (like flipping 20 heads in a row). Weight difference of 0.9 kg gain vs CGM group (P = 0.10): People on GLP-1 drugs gained less than a kilogram more than the comparison group, but this could easily be due to random variation (like flipping 6 heads out of 10 coins). Weight gain of 1.9 kg in non-GLP-1 users (P = 0.007): People not on GLP-1 drugs gained nearly 2 kg more than the comparison group - this definitely wasn't just luck.

Why This Matters

This shows that even patients already on the newest, most effective diabetes medications can still benefit significantly from automated insulin delivery, achieving better blood sugar control without the usual weight gain penalty. For doctors, this validates using these technologies together rather than viewing them as either-or choices.

Original Abstract

To assess the effect of automated insulin delivery (AID) on glycemic and insulin outcomes in adults with insulin-treated type 2 diabetes using a glucagon-like peptide-1 receptor agonist (GLP-1 RA). In a randomized trial comparing Control-IQ+ AID versus continuation of prestudy insulin delivery method plus continuous glucose monitoring (CGM group), 143 (45%) of the 319 participants were using a GLP-1 RA at baseline, which was continued during the trial. Among GLP-1 RA users, mean HbA1c decreased by 0.8% from a baseline of 8.0 ± 1.2% with AID, which represented a mean improvement of -0.5% (95% CI -0.8 to -0.3, P < 0.001) compared with the CGM group. Time-in-range 70-180 mg/dL and other CGM metrics reflective of hyperglycemia also showed comparable statistically significant improvements using AID when added to GLP-1 RA use. For GLP-1 RA users, there was no significant difference in weight after 13 weeks with AID compared with the CGM group (0.9 kg, 95% CI -0.2 to 2.1, P = 0.10), whereas, in GLP-1 RA nonusers, there was a mean weight gain of 1.9 kg with AID compared with CGM (95% CI 0.5 to 3.2, P = 0.007). The benefits of AID appear to be substantial for a broad spectrum of insulin-treated patients with type 2 diabetes, including those already receiving contemporary and guideline-directed therapy, such as a GLP-1 RA medication. These additive benefits of AID in GLP-1 RA users included significant reductions in HbA1c levels with simultaneous reduction in insulin use, along with no statistical increase in weight despite very significant improvements in glycemic control.