The article is interesting as it provides information on acute diabetes complications following AID initiation over a 12-month period in a real-world setting.

Major comments:

• A recent meta-analysis confirmed the efficacy and safety of AID systems in these settings (16) -> It would be noteworthy to cite the latest meta-analysis published in the field.

Di Molfetta S, Di Gioia L, Caruso I, Caporusso M, Trerotoli P, Natalicchio A, Perrini S, Laviola L, Giorgino F. Glycaemic control and variability with different commercially available hybrid closed loop systems in people with type 1 diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2025 Sep 29. doi: 10.1111/dom.70150. Epub ahead of print. PMID: 41024422.

• Could you please provide more details about how information on severe hypoglycemia and DKA was collected? I understand that these events were adjudicated by an independent study monitoring party, but was the original data self-reported by participants or obtained from administrative databases?

• I’m aware that DBLG1 is widely used in France (moreover, most scientific publications on this system are authored by French researchers). However, in this cohort, systems other than MiniMed 780G and Control-IQ account for only about 1%. The authors should comment on this discrepancy. Could this reflect a selection bias?

• The proportion of patients who did not receive HSP support before (28%) and during (44%) AID initiation is quite high, and the authors should comment on this.

In particular, the fact that 44% of users did not receive HSP support during AID initiation appears to conflict with the proposed explanation for the reduction in SH and DKA events, which has been attributed to the specific support provided to people with type 1 diabetes and healthcare professionals in France.

• A significant reduction in hypoglycemia (both TBR and SH) was observed only in individuals aged 14–24 and 25–64 years. The authors should comment on this finding and provide potential explanations. Did they evaluate any predictors for the reduction in TBR and/or SH?

• It would be interesting if the authors could present outcomes separately for MiniMed 780G and Control-IQ users.

• I understand that information about device settings was not available, but is there any data at least on the frequency and type of contacts with HSPs during the month following AID initiation?

• What about hospitalizations for causes other than SH and DKA, as well as the development or progression of microvascular and macrovascular diabetes complications following AID initiation?