Diabetes & Metabolism Journal

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

Transitioning between automated insulin delivery systems: A focus on personalisation
Pilar Isabel Beato-Víbora, Ana Chico, Jesus Moreno-Fernandez, Sharona Azriel-Mira, Lia Nattero-Chávez, Rosario Vallejo Mora, Núria Alonso-Carril, Olga Simó-Servat, Eva Aguilera-Hurtado, Luz María Reyes Céspedes, Marisol Ruiz de Adana, Marta Domínguez, Ros
Diabetes Research and Clinical Practice.2025; 222: 112070. CrossRef
Advances in Continuous Glucose Monitoring: Clinical Applications
So Yoon Kwon, Jun Sung Moon
Endocrinology and Metabolism.2025; 40(2): 161. CrossRef
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

COVID-19
Impact of COVID-19 Lockdown on the Metabolic Control Parameters in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis: Ifan Ali Wafa, Nando Reza Pratama, Nurizzah Farahiyah Sofia, Elsha Stephanie Anastasia, Tiffany Konstantin, Maharani Ayuputeri Wijaya, M. Rifqi Wiyono, Lilik Djuari, Hermina Novida; Diabetes Metab J. 2022;46(2):260-272. Published online March 8, 2022; DOI: https://doi.org/10.4093/dmj.2021.0125

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295 Download
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Background
Abrupt implementation of lockdowns during the coronavirus disease 2019 (COVID-19) pandemic affected the management of diabetes mellitus in patients worldwide. Limited access to health facilities and lifestyle changes potentially affected metabolic parameters in patients at risk. We conducted a meta-analysis to determine any differences in the control of metabolic parameters in patients with diabetes, before and during lockdown.
Methods
We performed searches of five databases. Meta-analyses were carried out using random- or fixed-effect approaches to glycaemic control parameters as the primary outcome: glycosylated hemoglobin (HbA1c), random blood glucose (RBG), fasting blood glucose (FBG), time-in-range (TIR), time-above-range (TAR), time-below-range (TBR). Mean difference (MD), confidence interval (CI), and P value were calculated. Lipid profile was a secondary outcome and is presented as a descriptive analysis.
Results
Twenty-one studies enrolling a total of 3,992 patients with type 1 or type 2 diabetes mellitus (T1DM or T2DM) were included in the study. Patients with T1DM showed a significant improvement of TIR and TAR (MD=3.52% [95% CI, 0.29 to 6.74], I²=76%, P=0.03; MD=–3.36% [95% CI, –6.48 to –0.25], I²=75%, P=0.03), while FBG among patients with T2DM significantly worsened (MD=3.47 mg/dL [95% CI, 1.22 to 5.73], I²=0%, P<0.01). No significant difference was found in HbA1c, RBG, and TBR. Use of continuous glucose monitoring in T1DM facilitated good glycaemic control. Significant deterioration of lipid parameters during lockdown, particularly triglyceride, was observed.
Conclusion
Implementation of lockdowns during the COVID-19 pandemic did not worsen glycaemic control in patients with diabetes. Other metabolic parameters improved during lockdown, though lipid parameters, particularly triglyceride, worsened.

Citations

Citations to this article as recorded by

Evolution of Cardiovascular Risk Factors Related to BMI and Metabolic Control in Children and Adolescents With Type 1 Diabetes Mellitus: A Cohort Study
Daniella Rodriguez Curval, Wilza A. F. Peres, Lívia C. de Oliveira, Jorge Luercher, Amanda de Andrade Almeida da Silva, Beatriz Bastos de Araujo, Ludmila Nascimento Rodrigues Campos, Patricia de Carvalho Padilha, Rasha Hamza
Pediatric Diabetes.2025;[Epub] CrossRef
Disruption of diabetes and hypertension care during the COVID-19 pandemic and recovery approaches in the Latin America and Caribbean region: a scoping review protocol
Samira Barbara Jabakhanji, Oluwabunmi Ogungbe, Sonia Y Angell, Lawrence Appel, David Byrne, Roopa Mehta, John McCaffrey, Lori Rosman, Edward W Gregg, Kunihiro Matsushita
BMJ Open.2024; 14(1): e074443. CrossRef
Influence of the COVID-19 pandemic on the achievement of guideline targets for HbA1c, blood pressure, and LDL cholesterol in people with diabetes in Japan
Shingo Kuwajima, Takahito Itoh, Tatsuya Sato, Shoya Ino, Satoru Shibata, Kouhei Ohno, Hiroyuki Hotta, Tomoaki Matsumoto, Hitoshi Ooiwa, Hirofumi Kubo, Takayuki Miki
Diabetology International.2024; 15(3): 507. CrossRef
Effect of the SARS-CoV-2 pandemic on metabolic control in patients with type 2 diabetes: a 5-year cohort follow-up managed by a dynamic multidisciplinary team in Northeastern Mexico
Devany Paola Morales-Rodriguez, Arnulfo González-Cantú, Arnulfo Garza-Silva, Andrea Rivera-Cavazos, Iván Francisco Fernández-Chau, Andrea Belinda Cepeda-Medina, Miguel Angel Sanz-Sánchez, Gerardo Francisco del Rio-Parra, María Angelina Torres-Fuentes, Mig
Diabetology & Metabolic Syndrome.2024;[Epub] CrossRef
Excellence in the management of Advanced Hybrid Closed-Loop Systems: Lessons from the Polish cohort
Bartłomiej Matejko, Tim van den Heuvel, Javier Castaneda, Arcelia Arrieta, Katarzyna Cyranka, Ohad Cohen, Maciej Małecki, Tomasz Klupa
Diabetes Research and Clinical Practice.2024; 216: 111832. CrossRef
Impact of the COVID-19 Pandemic on Lifestyle Behavior and Clinical Care Pathway Management in Type 2 Diabetes: A Retrospective Cross-Sectional Study
Giovanni Cangelosi, Stefano Mancin, Paola Pantanetti, Marco Sguanci, Sara Morales Palomares, Alessia De Luca, Federico Biondini, Francesco Tartaglia, Gaetano Ferrara, Fabio Petrelli
Medicina.2024; 60(10): 1624. CrossRef
Age-dependent effects of lockdown and post-lockdown periods on HbA1c during the COVID-19 pandemic: A 3-year longitudinal cohort study
Vehbi Şirikçi, Cem Onur Kiraç, Hüseyin Avni Findikli
Medicine.2024; 103(49): e40873. CrossRef
Glycemic Control in Type 1 Diabetes Mellitus and COVID-19: What We Learned From the Lockdown Experience
Catarina Almeida, André Ferreira, Daniela Duarte, Ana Filipa Viegas, André Santos, Alexandra Vaz, Edite Nascimento
Cureus.2023;[Epub] CrossRef
Changes in body weight and glycemic control in association with COVID-19 Shutdown among 23,000 adults with type 2 diabetes
Emily Panza, Kevin E. Kip, Kripa Venkatakrishnan, Oscar C. Marroquin, Rena R. Wing
Acta Diabetologica.2023; 60(6): 787. CrossRef
The Impact of a Lockdown for the COVID-19 Pandemic on Seasonal HbA1c Variation in Patients with Type 2 Diabetes
Yu-Cheng Cheng, Yu-Hsuan Li, Hsiu-Chen Liu, Chiann-Yi Hsu, Wan-Jen Chang, I-Te Lee, Chin-Li Lu
Life.2023; 13(3): 763. CrossRef
The Impact of Partial Lockdown During COVID-19 Pandemic on Metabolic Control in People with Type 2 Diabetes Mellitus
Ayşe Zülal TOKAÇ, Tuğde Buse UĞUR, Buse Ecem KURUGÖL, Sevilay ALİGÜLÜ, Osman HAYRAN
Journal of Biotechnology and Strategic Health Research.2023; 7(1): 67. CrossRef
Retrospective Study on the Impact of COVID-19 Lockdown on Patients with Type 2 Diabetes in Northern Taiwan
Hsuan Huang, Hsiao-Ling Su, Chih-Hsung Huang, Yi-Hsin Lin
Diabetes, Metabolic Syndrome and Obesity.2023; Volume 16: 2539. CrossRef
RIPK1 and RIPK3 inhibitors: potential weapons against inflammation to treat diabetic complications
Dan Ke, Zhen Zhang, Jieting Liu, Peijian Chen, Yucen Dai, Xinhai Sun, Yanhui Chu, Luxin Li
Frontiers in Immunology.2023;[Epub] CrossRef
“Does Physical Exercise Promote Health Benefits for Diabetic Patients during the COVID-19 Pandemic?”: A Systematic Review
Erivaldo de Souza, Daniela Meneses-Santos, Josué Cruz Santos, Felipe J. Aidar, Carla Roberta de Oliveira Carvalho, Jymmys Lopes dos Santos, Anderson Carlos Marçal
Sports.2023; 11(10): 192. CrossRef
Impact of National Lockdown From COVID-19 Pandemic in Patients With Type 2 Diabetes: An Observational Study
Nuntakorn Thongtang, Niracha Chanwimol, Lukana Preechasuk, Varisara Boonyuang, Pinyo Rattanaumpawan, Supawadee Likitmaskul, Apiradee Sriwijitkamol
Asia Pacific Journal of Public Health.2022; 34(6-7): 708. CrossRef

Cardiovascular Risk/Epidemiology
Appraisal of Guidelines for the Management of Blood Pressure in Patients with Diabetes Mellitus: The Consensuses, Controversies and Gaps: Menghui Liu, Shaozhao Zhang, Xiaohong Chen, Yue Guo, Xiangbin Zhong, Zhenyu Xiong, Yifen Lin, Huimin Zhou, Yiquan Huang, Zhengzhipeng Zhang, Lichun Wang, Xiaodong Zhuang, Xinxue Liao; Diabetes Metab J. 2021;45(5):753-764. Published online April 23, 2021; DOI: https://doi.org/10.4093/dmj.2020.0134

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Abstract PDF Supplementary Material PubReader ePub: Background
Currently available guidelines contain conflicting recommendations on the management of blood pressure (BP) in patients with diabetes mellitus (DM). Therefore, it is necessary to appraise the guidelines and summarize the agreements and differences among recommendations.
Methods
Four databases and the websites of guideline organizations were searched for guidelines regarding BP targets and thresholds for pharmacologic therapy in DM patients, and the included guidelines were appraised with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.
Results
In 6,498 records identified, 20 guidelines met our inclusion criteria with 64.0% AGREE II scores (interquartile range, 48.5% to 72.0%). The scores of the European and American guidelines were superior to those of the Asian guidelines (both adjusted P<0.001). Most of the guidelines advocated systolic BP targets <130 mm Hg (12 guidelines, 60%) and diastolic BP targets <80 mm Hg (14 guidelines, 70%) in DM patients. Approximately half of the guidelines supported systolic BP thresholds >140 mm Hg (10 guidelines, 50%) and diastolic BP thresholds >90 mm Hg (nine guidelines, 45%). The tiny minority of the guidelines provided the relevant recommendations regarding the lower limit of official BP targets and the ambulatory BP monitoring (ABPM)/home BP monitoring (HBPM) targets and thresholds in DM patients.
Conclusion
The lower official BP targets (<130/80 mm Hg) in patients with DM are advocated by most of the guidelines, but they contain conflicting recommendations on the official BP thresholds. Moreover, the gaps regarding the lower limit of official BP targets and the ABPM/HBPM targets and thresholds need to be considered by future study.

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