Diabetes & Metabolism Journal

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Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis (Diabetes Metab J 2025;49:235-51): Wenqi Fan, Chao Deng, Zhiguang Zhou, Xia Li; Diabetes Metab J. 2025;49(3):520-521. Published online May 1, 2025; DOI: https://doi.org/10.4093/dmj.2025.0282

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Original Articles

Technology/Device
Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis: Wenqi Fan, Chao Deng, Ruoyao Xu, Zhenqi Liu, Richard David Leslie, Zhiguang Zhou, Xia Li; Diabetes Metab J. 2025;49(2):235-251. Published online November 13, 2024; DOI: https://doi.org/10.4093/dmj.2024.0130

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Background
Automated insulin delivery (AID) systems studies are upsurging, half of which were published in the last 5 years. We aimed to evaluate the efficacy and safety of AID systems in patients with type 1 diabetes mellitus (T1DM).
Methods
We searched PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov until August 31, 2023. Randomized clinical trials that compared AID systems with other insulin-based treatments in patients with T1DM were considered eligible. Studies characteristics and glycemic metrics was extracted by three researchers independently.
Results
Sixty-five trials (3,623 patients) were included. The percentage of time in range (TIR) was 11.74% (95% confidence interval [CI], 9.37 to 14.12; P<0.001) higher with AID systems compared with control treatments. Patients on AID systems had more pronounced improvement of time below range when diabetes duration was more than 20 years (–1.80% vs. –0.86%, P=0.031) and baseline glycosylated hemoglobin lower than 7.5% (–1.93% vs. –0.87%, P=0.033). Dual-hormone full closed-loop systems revealed a greater improvement in TIR compared with hybrid closed-loop systems (–19.64% vs. –10.87%). Notably, glycemia risk index (GRI) (–3.74; 95% CI, –6.34 to –1.14; P<0.01) was also improved with AID therapy.
Conclusion
AID systems showed significant advantages compared to other insulin-based treatments in improving glucose control represented by TIR and GRI in patients with T1DM, with more favorable effect in euglycemia by dual-hormone full closedloop systems as well as less hypoglycemia for patients who are within target for glycemic control and have longer diabetes duration.

Citations

Citations to this article as recorded by

A systematic literature review and meta‐analysis of real‐world evidence on commercially available automated insulin delivery systems in people with type 1 diabetes
Johannes Pöhlmann, Jayne Smith‐Palmer, Erik H. Serné, Anna‐Kaisa Tuomaala, Johan Jendle, Pratik Choudhary, Emanuele Bosi, Viswanathan Mohan, Tim van den Heuvel, Ohad Cohen, Richard F. Pollock
Diabetes, Obesity and Metabolism.2026; 28(S1): 13. CrossRef
A nationwide 12‐month observatory of automated insulin delivery shows improved glucose control, sustained adoption, and reduced acute severe events
Jean‐Pierre Riveline, Jean‐Baptiste Julla, Elisabeth Bonnemaison, Michael Joubert, Sandrine Lablanche, Agnès Sola Gazagnes, Delphine Demarsy, Didier Gouet, Pauline Schaepelynck, Chloé Amouyal, Fabienne Dalla Vale, Anne Schletzer‐Mari, Sylvaine Clavel, Ann
Diabetes, Obesity and Metabolism.2026; 28(2): 1179. CrossRef
Impact of stepwise diabetes technology advances in older adults with type 1 diabetes: A systematic review and meta‐analysis of randomised trials
Mengyun Lei, Yongwen Zhou, Ying Ni, Zhiqin Lin, Qiongyan Lin, Ping Ling, Daizhi Yang, Wen Xu, Hongrong Deng, Jinhua Yan
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Diabetes Care.2026; 49(Supplement): S150. CrossRef
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Jennifer R. Snaith, Phoom Narongkiatikhun, Petter Bjornstad, Jerry R. Greenfield, Kalie L. Tommerdahl
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Renald Meçani, Silvia Basta, Petra M. Baumann, Monika Cigler, Omaima el Hakouni, Daniel A. Hochfellner, Fariba Shojaee‐Moradie, Ka Siu Fan, Dietrich Tews, Thomas R. Pieber, David Russell‐Jones, Chantal Mathieu, Gerd Koehler, Julia K. Mader
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Use of hybrid closed-loop insulin pump in pancreatogenic diabetes following necrotizing hemorrhagic pancreatitis: a case report
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Automated Insulin Delivery Associated with Superior Glycemic Outcomes in Type 1 Diabetes: A Swedish National Registry Analysis
Fredrik Ståhl, Jarl Hellman, Charlotte Ekelund
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Insights for personalized choice of a hybrid closed–loop system: an expert opinion
S. Di Molfetta, F. Boscari, A. Rossi, A. Girelli, G. Lepore, L. Bozzetto, C. Irace, L. Laviola, D. Bruttomesso
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Eda Cengiz, Roy W. Beck
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Nancy L. Beck
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Alexia Aouba, Bleuenn Dreves, Julia Morera, Anne Rod, Mona Guetlin, Michael Joubert
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Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis (Diabetes Metab J 2025;49:235-51)
Wenqi Fan, Chao Deng, Zhiguang Zhou, Xia Li
Diabetes & Metabolism Journal.2025; 49(3): 520. CrossRef
Critical Insights into the Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus (Diabetes Metab J 2025;49:235-51)
Sami Ullah, Ayesha Ahmad, Kamil Ahmad Kamil, Minahil Laraib Asif, Abdullah Jan
Diabetes & Metabolism Journal.2025; 49(3): 516. CrossRef
Automatisierte Insulinabgabesysteme (AID) in der Diabetestherapie: der neue Goldstandard?
Sandra Schlüter, Dorothee Deiss, Delia Waldenmaier
Die Diabetologie.2025; 21(8): 840. CrossRef
Hypoglycemia incidence and behavioural adjustments during free‐living unstructured physical activity in adults with type 1 diabetes using AID systems: Results from the RAPPID study
Michael Joubert, Laurent Meyer, Said Bekka, Luc Rakotoarisoa, Nicolas Scheyer, Bleuenn Dreves, Bruno Guerci
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Improving Time-in-Range in Type 1 Diabetes: Projecting the Clinical and Cost Implications of Automated Insulin Delivery
Sufyan Hussain, Asli Zeynep Ozdemir Saltik, Jessica J. Yu, Simona de Portu, Richard F. Pollock, Johannes Pöhlmann, Ohad Cohen
Diabetes Technology & Therapeutics.2025;[Epub] CrossRef
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Abul Bashar Mohammad Kamrul-Hasan, Joseph M Pappachan, Lakshmi Nagendra, Nazma Akter, Sweekruti Jena, Deep Dutta, Sunil Nair
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Technology/Device
Glutamic Acid Decarboxylase Autoantibody Detection by Electrochemiluminescence Assay Identifies Latent Autoimmune Diabetes in Adults with Poor Islet Function: Yuxiao Zhu, Li Qian, Qing Liu, Jing Zou, Ying Zhou, Tao Yang, Gan Huang, Zhiguang Zhou, Yu Liu; Diabetes Metab J. 2020;44(2):260-266. Published online November 12, 2019; DOI: https://doi.org/10.4093/dmj.2019.0007

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153 Download
18 Web of Science
20 Crossref

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Background

The detection of glutamic acid decarboxylase 65 (GAD65) autoantibodies is essential for the prediction and diagnosis of latent autoimmune diabetes in adults (LADA). The aim of the current study was to compare a newly developed electrochemiluminescence (ECL)-GAD65 antibody assay with the established radiobinding assay, and to explore whether the new assay could be used to define LADA more precisely.

Methods

Serum samples were harvested from 141 patients with LADA, 95 with type 1 diabetes mellitus, and 99 with type 2 diabetes mellitus, and tested for GAD65 autoantibodies using both the radiobinding assay and ECL assay. A glutamic acid decarboxylase antibodies (GADA) competition assay was also performed to assess antibody affinity. Furthermore, the clinical features of these patients were compared.

Results

Eighty-eight out of 141 serum samples (62.4%) from LADA patients were GAD65 antibody-positive by ECL assay. Compared with ECL-GAD65 antibody-negative patients, ECL-GAD65 antibody-positive patients were leaner (P<0.0001), had poorer β-cell function (P<0.05), and were more likely to have other diabetes-associated autoantibodies. The β-cell function of ECL-GAD65 antibody-positive patients was similar to that of type 1 diabetes mellitus patients, whereas ECL-GAD65 antibody-negative patients were more similar to type 2 diabetes mellitus patients.

Conclusion

Patients with ECL-GAD65 antibody-negative share a similar phenotype with type 2 diabetes mellitus patients, whereas patients with ECL-GAD65 antibody-positive resemble those with type 1 diabetes mellitus. Thus, the detection of GADA using ECL may help to identify the subtype of LADA.

Citations

Citations to this article as recorded by

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Enhanced Electrochemiluminescence from Ruthenium-Tagged Immune Complex at Flexible Chains for Sensitive Analysis of Glutamate Decarboxylase Antibody
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Alexander Lenard, Andreas Rapp, Steffen Busch, Peter Findeisen
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Niki G. Mourelatou, Dimitris Kounatidis, Edward B. Jude, Eleni Rebelos
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Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, Raveendhara R. Bannuru, Florence M. Brown, Dennis Bruemmer, Billy S. Collins, Jason L. Gaglia, Marisa E. Hilliard, Diana Isaacs, Eric L. Johnson, Scott Kahan, Kamlesh Khunti, Jose Leon, Sarah K. Lyons, Mary
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Diabetes Care.2022; 45(Supplement): S17. CrossRef
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Xixi Nan, Xia Li, Yufei Xiang, Xiang Yan, Houde Zhou, Xiaohan Tang, Jin Cheng, Xiaohong Niu, Jing Liu, Qiuhe Ji, Linong Ji, Gan Huang, Zhiguang Zhou
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Shivajirao Prakash Patil
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Wenfeng Yin, Shuoming Luo, Zilin Xiao, Ziwei Zhang, Bingwen Liu, Zhiguang Zhou
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