In this study, we aimed to explore the impact of meal carbohydrate (CHO) content on postprandial hyperglycemia in hospitalized patients receiving fully automated insulin delivery (AID). We performed a post-hoc analysis of two trials and analyzed 844 postprandial periods from 48 adults treated with fully AID (FlorenceD2W-T2 or CamAPS HX) in hospital using generalized additive regression models. Meal CHO content had a nonlinear effect on postprandial hyperglycemia risk (P < 0.001). Postprandial hyperglycemia was more likely at breakfast compared with lunch and dinner (odds ratio or OR [95% confidence interval or CI] 1.8 [1.2, 2.6], P = 0.006; and 1.5 [1.1, 2.2], P = 0.05, respectively) and more frequent on days with glucocorticoid administration (OR [95% CI] 3.3 [2.1, 5.1]; P < 0.001). In conclusion, during fully AID in hospitalized patients, the risk of postprandial hyperglycemia remained <50% for meals ≤50 g CHO. The CHO tolerance was lowest at breakfast and with concomitant glucocorticoid therapy across all meals.
