BACKGROUND: To evaluate the progression of diabetic retinopathy (DR) after the initiation of automated insulin delivery (AID) systems in adults with type 1 diabetes (T1D). METHODS: In this longitudinal study with 152 adults, retinal exams and clinical variables were collected before and after AID initiation up to 2.7 years. The DR worsening was defined as an increase in Early Treatment of Diabetic Retinopathy Study (ETDRS) scores or qualitative retinal exam. RESULTS: A total of 152 adults with mean age of 42 years (57% female), 26 years of T1D duration, and mean baseline HbA CONCLUSIONS: Higher baseline HbA