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

doi:10.4093/dmj.2025.0282

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Response 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):520-521.
DOI: https://doi.org/10.4093/dmj.2025.0282
Published online: May 1, 2025

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National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China

Corresponding authors: Xia Li

National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, 139 Remin Middle Road, Furong Disrtrict, Changsha, Hunan Province, China E-mail: lixia@csu.edu.cn

Zhiguang Zhou

*Wenqi Fan and Chao Deng contributed equally to this study as first authors.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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See the letter "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)" on page 516.

We appreciate the insightful comments by the reviewers on our recent article and are happy to clarify and discuss the points they raised [1]. Given the surge in clinical research on automated insulin delivery (AID) systems over the past 5 years and the concurrent absence of comprehensive evaluations of these systems, our study aims to include all eligible studies and conduct a thorough, integrated assessment of the efficacy and safety of AID systems. This approach inevitably introduces heterogeneity into the research, a characteristic that aligns with previous AID studies that included all populations [2,3]. To address this heterogeneity, we performed multiple subgroup analyses based on the following factors: intervention duration, hormone type, age, follow-up period, baseline glycosylated hemoglobin levels, remote monitoring, disease duration, AID system type, control group design, and algorithm type (Table 2 in the main text). Additionally, we conducted a sensitivity analysis to confirm the reliability of the results. Clinical heterogeneity across studies is understandable, as AID systems are inherently required to operate under variable clinical conditions from a practical standpoint.

We concur with the reviewers that a cost-effectiveness analysis of AID systems is essential. Emerging evidence from recent studies suggests that certain AID systems (e.g., Omnipod 5, Control IQ, and Cambridge algorithm-based systems) are cost-effective and potentially cost-saving for patients with type 1 diabetes mellitus (T1DM) [4-6]. However, broader evaluations across more AID systems, larger populations, and longer follow-ups are still needed to confirm generalizability.

The significance of any technological advancement lies in its ability to not only improve blood glucose control but also reduce psychological burden, thereby truly maximizing patient benefits and holding great clinical importance. Previous metaanalysis has demonstrated decreased diabetes distress and a tendency for reduced fear of hypoglycemia when using hybrid AID systems. However, no significant differences were observed in treatment satisfaction. This may be attributed to the fact that most studies included in the analyses still required manual bolus input [7]. With iterative algorithm updates, we believe that fully AID systems without carbohydrate counting will significantly reduce disease burden and improve psychological outcomes. We have conducted preliminary analyses on fully AID systems, revealing improved diabetes treatment satisfaction (unpublished data).

Assessing AID systems in special populations remains a critical research priority. Existing evidence demonstrates the efficacy of AID technology in improving glycemic outcomes among pregnant women with T1DM [8]. Future studies should focus on underserved populations to enhance applicability by addressing their unique physiological/behavioral challenges.

Overall, we appreciate the constructive feedback from the reviewers and will consider these suggestions in future studies. These recommendations will enhance the generalizability of AID systems and effectively address the unmet clinical needs in this field.

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CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

REFERENCES

1. Fan W, Deng C, Xu R, Liu Z, Leslie RD, Zhou Z, et al. Efficacy and safety of automated insulin delivery systems in patients with type 1 diabetes mellitus: a systematic review and metaanalysis. Diabetes Metab J 2025;49:235-51.Article PubMed PDF
2. Bekiari E, Kitsios K, Thabit H, Tauschmann M, Athanasiadou E, Karagiannis T, et al. Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis. BMJ 2018;361:k1310.Article PubMed PMC
3. Weisman A, Bai JW, Cardinez M, Kramer CK, Perkins BA. Effect of artificial pancreas systems on glycaemic control in patients with type 1 diabetes: a systematic review and meta-analysis of outpatient randomised controlled trials. Lancet Diabetes Endocrinol 2017;5:501-12.Article PubMed
4. Biskupiak JE, Ramos M, Levy CJ, Forlenza G, Hopley C, Boyd J, et al. Cost-effectiveness of the tubeless automated insulin delivery system vs standard of care in the management of type 1 diabetes in the United States. J Manag Care Spec Pharm 2023;29:807-17.Article PubMed
5. Adolfsson P, Heringhaus A, Sjunnesson K, Mehkri L, Bolin K. Cost-effectiveness of the tandem t: Slim X2 with control-IQ technology automated insulin delivery system in children and adolescents with type 1 diabetes in Sweden. Diabet Med 2024;41:e15432.PubMed
6. Fox DS, Ware J, Boughton CK, Allen JM, Wilinska ME, Tauschmann M, et al. Cost-effectiveness of closed-loop automated insulin delivery using the Cambridge hybrid algorithm in children and adolescents with type 1 diabetes: results from a multicenter 6-month randomized trial. J Diabetes Sci Technol 2024 Mar 17 [Epub]. https://doi.org/10.1177/19322968241231950.Article
7. Godoi A, Reis Marques I, Padrao EM, Mahesh A, Hespanhol LC, Riceto Loyola Junior JE, et al. Glucose control and psychosocial outcomes with use of automated insulin delivery for 12 to 96 weeks in type 1 diabetes: a meta-analysis of randomised controlled trials. Diabetol Metab Syndr 2023;15:190.Article PubMed PMC PDF
8. Lee TT, Collett C, Bergford S, Hartnell S, Scott EM, Lindsay RS, et al. Automated insulin delivery in women with pregnancy complicated by type 1 diabetes. N Engl J Med 2023;389:1566-78.Article PubMed

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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)

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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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)

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Fan W, Deng C, Zhou Z, Li X. 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). Diabetes Metab J. 2025;49(3):520-521.

DOI: https://doi.org/10.4093/dmj.2025.0282.

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