Automated Insulin Delivery in Adults With Advanced Kidney Disease

Inclusion Criteria: * 1\. Age 18-70 years inclusive * 2\. Type 1 diabetes of at least 1-year duration or insulin-requiring type 2 diabetes managed with multiple daily injections (MDI \[ie separate rapid-acting and basal insulin injections\]) or insulin pump therapy (CSII) * 3\. The HbA1c \<10.5% (\<91 mmol/mol) * 4\. The total daily dose of insulin \<200Units * 5\. The participant is willing and able to implement the study requirements. * 6\. Participant has advanced renal disease (Group A: Stage 3b or greater renal failure (eGFR \<45millilitres/minute/1.73m2); Group B: ESKD requiring peritoneal dialysis; Group C: ESKD requiring haemodialysis * 7\. Participants (and carer where applicable) should be able to speak and understand English sufficiently for safe study conduct * 8\. The participant has internet or smartphone access, enabling upload of the 780G system data to cloud-based software Exclusion Criteria: * 1\. The participant is already using an AID system * 2\. The participant is treated with sulphonylureas (SGLT2 inhibitors, metformin, and GLP1 analogues may be used within regulatory guidelines) in pre-dialysis participants (Group A). In Groups B \& C, noninsulin glucose-lowering therapies are not permitted, with the exception of GLP1 agonists used in preparation for transplantation * 3\. The participant has a recent history of diabetic ketoacidosis (\<6 months) * 4\. The use of systemic steroid therapy within the past four weeks (stable doses of steroids for \>8 weeks permitted) * 5\. The participant has significant cognitive impairment or major psychiatric history affecting safe study conduct * 6\. Known significant allergy to tape/ adhesives * 7\. Women who are pregnant or planning pregnancy * 8\. The participant has an active major life-threatening illness limiting the participants life expectancy to \<6 months * 9\. The participant is on hydroxyurea treatment or taking regular / daily paracetamol treatment (sensor interference)