311-OR: Adapting Automated Insulin Delivery for Menstrual Cycle Variability in Type 1 Diabetes—Insights from a Combined Quantitative and Qualitative Study

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Introduction and Objective: Premenopausal women with type 1 diabetes (T1D) experience fluctuations in glucose levels related to their menstrual cycles. Research and anecdotal reports from the diabetes community indicate that insulin needs change across cycle phases, and many women make manual adjustments to Automated Insulin Delivery (AID) systems to ensure appropriate insulin delivery. However, the specifics of these adjustments and the reasoning for adopted strategies to manage cycle-induced changes on glucose control are not yet well understood and warrant further research. Methods: In collaboration with Tidepool, we analyzed 354 menstrual cycles from donated data provided by 70 women with T1D using an AID system. This quantitative study was complemented by qualitative research consisting of 7 focus groups with semi-structured interviews involving 38 women. Results: Both studies confirmed significant variability in insulin requirements throughout the menstrual cycle, with no consistent patterns across individuals or AID systems. In the quantitative study, 43% of the women regularly adjusted their insulin delivery settings to counteract hormone-related fluctuations. Women who adjusted their insulin settings achieved a statistically significant higher Time-in-Range, increasing by 5 percentage points compared to those who did not make adjustments. To address cycle-induced glycemic fluctuations, women primarily adjusted basal rates, target glucose levels, and correction factors, often supplementing with ad-hoc strategies such as fake carbs or under-bolusing. Conclusion: 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. Disclosure S. Hossmann: None. S. Bühler-Häfliger: None. S. Khan-Gallo: Employee; Tidepool. Advisory Panel; Diabetes Center Berne. M. Friedman: None. L. Burlando: None. S. Krutisch: Employee; Abbott. H. Ballhausen: None. S. Rossi: None. A. Lizoain: None. V.S. Braunack-Mayer: None. M. Rothenbühler: None.

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