955-P: Effective Use of U-200 Insulin in OmniPod 5, Medtronic 780G, and Tandem X2 Systems

Objectives: Commercially available insulin pumps are approved for U-100 insulin. Patients with high insulin dose requirements need to change infusion sets every 1-2 days, creating inconvenience and increasing costs. We evaluated the safety and feasibility of using U-200 insulin in hybrid closed-loop systems. Methods: We reviewed clinical data and insulin pump uploads from three patients using U-200 insulin in their pumps, each diagnosed with a different type of diabetes: Type 1, Type 2, and post-pancreatitis. Each patient used a different hybrid closed-loop system in automated mode: OmniPod 5, Medtronic 780G, and Tandem X2. Insulin doses were reduced by 50% when programming the pump settings for U-200, with minor individual variations. Results: Using U-200 insulin extended the infusion set wear from 1-2 days to 3 days. For the patient using the Medtronic 780G, Time in Range (TIR) improved by 57% in the month after transitioning to U-200 insulin. The Glucose Management Indicator (GMI) decreased from 9.6% to 7.4%, with SmartGuard mode active 73% of the time. Similarly, for the patient using the Tandem X2, TIR increased by 33% over a month, and GMI improved from 8.7% to 7.5%, with the patient in Control IQ mode 94% of the time. The patient using OmniPod 5 showed a 6% improvement in TIR and was in automated mode 100% of the time, with GMI improving from 6.7% to 6.5%. There was no increase in time spent in hypoglycemia with U-200 insulin. All three patients reported enhanced quality of life and increased satisfaction with their pump therapy. Conclusion: The use of U-200 insulin in hybrid closed-loop system algorithms was safe and effective, offering a viable option for automated insulin delivery systems (AIDS) in patients with high insulin needs. This approach could also broaden the application of AIDS to different types of diabetes, as evidenced by our patients. This is the first reported case series to date. Further studies are necessary to establish standardized recommendations for using concentrated insulins in AIDS.