- βAID reduced HbA1c by an average of 34 mmol/mol more than usual care β a major blood sugar improvement
- βYoung people using AID reported significantly less daytime tiredness and sleep-related impairment
- βAll 80 participants completed the full 13-week trial, showing AID is feasible even in those with poorly controlled diabetes
| Journal | Diabetic medicine : a journal of the British Diabetic Association |
| Year | 2025 |
| Authors | Michaels, Boucsein, Haszard |
| PMID | 40534171 |
What Was Studied and Why It Matters
Managing type 1 diabetes (T1D) is a round-the-clock job β and for children and young adults, nighttime blood sugar swings can steal precious sleep from both patients and their caregivers. Researchers behind the CO-PILOT trial wanted to know whether automated insulin delivery (AID) systems β sometimes called "closed-loop" or "artificial pancreas" technology β could improve sleep alongside blood sugar control in young people whose diabetes was not well managed.
The study focused on participants aged 7 to 25 with HbA1c levels of 69 mmol/mol or higher, meaning their average blood sugar was consistently elevated. Over 13 weeks, 80 participants were randomly assigned either to use an AID system or to continue their usual diabetes care.
What the Researchers Found
The results were a mixed bag β encouraging in some ways, surprising in others.
The Good News
- Blood sugar improved dramatically. Those using AID saw their HbA1c drop by an average of 34 mmol/mol more than the control group β a clinically significant improvement that could meaningfully reduce long-term diabetes complications.
- Daytime functioning got better. Participants using AID reported less sleep-related impairment β meaning they felt less tired and foggy during the day compared to those on usual care.
The Surprising Finding
- Objective sleep quality dipped slightly. When researchers used wrist accelerometers (motion-tracking devices) to measure actual sleep, AID users spent about 21 more minutes awake after initially falling asleep and had a 4% lower sleep efficiency compared to the control group.
- This suggests the AID devices β which make automatic insulin adjustments throughout the night β may be causing brief awakenings, possibly from pump alerts or the body responding to insulin changes.
What This Means for Real Patients and Families
If your child or teenager uses or is considering an AID system, this study offers important perspective. The technology delivers real, meaningful benefits for blood sugar control β and feeling less exhausted during the day is a genuine quality-of-life win. However, families should be aware that nighttime device alerts or automatic adjustments might cause some sleep fragmentation, at least initially.
Practical steps worth discussing with your diabetes care team include adjusting alert thresholds on the AID device to minimize unnecessary nighttime alarms and exploring good sleep hygiene habits alongside technology use. Ensuring you have reliable, properly functioning supplies β including sensors, pump components, and backup testing strips available through trusted sources like MDS Diabetes β can also reduce the stress and disruptions that come with unexpected equipment issues overnight.
The researchers conclude that improving sleep in young people with T1D likely requires more than better blood sugar control alone. Behavioral support, sleep education, and possibly mental health resources may all play a role.
Bottom Line
Automated insulin delivery systems significantly improved blood sugar levels and reduced daytime tiredness in children and young adults with poorly controlled T1D β but they also caused some measurable nighttime sleep disruption. Families should weigh these trade-offs with their care team and consider a well-rounded approach to sleep health that goes beyond diabetes technology alone.