Background. – This study aimed to assess the efficacy of insulin pumps with automated predictive low-glucose insulin suspension in a real-world setting compared with stand-alone flash glucose monitoring (FGM).

Methods. – The data analyzed were uploaded by patients with type 1 diabetes (n = 195) treated with external insulin pumps [either a MiniMed 640G system (Medtronic) including SmartGuard technology that predicts and manages low glucose (n = 61) or an Omnipod patch pump accompanied by a FreeStyle Libre sensor (Abbott) for FGM (n = 134)].

Results. – The median (25^th–75^th percentile) time spent with sensor glucose values ≤ 3.9 mmol/L was 0.9% (0.4–1.55) vs 5.6% (3.05–9.55) in the predictive low-glucose suspend group vs FGM users, respectively (P < 0.0001), with similar results obtained for median time spent with sensor glucose values ≤ 3 mmol/L (P < 0.0001). The group using sensor-integrated pumps had lower % coefficient of variation (CV) values and lower mean amplitude glycaemic excursions (P < 0.0001). Mean glucose values as well as measured HbA1c levels were also lower.

Conclusion. – These real-world data show that predictive low-glucose insulin suspension is more effective than pumps with stand-alone FGM for reducing hypoglycaemic events, and could be of benefit to patients at risk of hypoglycaemia as well as those lacking in hypoglycaemic awareness.