Abstract
Automated insulin delivery (AID) systems are the standard of care in type 1 diabetes. Recent studies suggest benefits of these systems for people with type 2 diabetes, as well.
To evaluate the effects of AID systems on glycemic outcomes in people with type 2 diabetes requiring insulin.
The PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched through 10 March 2025. This study was registered with PROSPERO (CRD420251036184).
Nine studies (n = 1,530 participants) were included that evaluated AID systems in people with type 2 diabetes reporting continuous glucose monitoring outcomes.
Data were collected on study characteristics and outcomes including time in range (TIR) (3.9-10.0 mmol/L [70-180 mg/dL]), time above range (TAR) (>10.0 mmol/L [>180 mg/dL]), time below range (TBR) (<3.9 mmol/L [<70 mg/dL]), mean glucose, and HbA1c. We performed a single-arm meta-analysis using a random-effects model.
AID systems significantly increased TIR by 16.06% (95% CI 10.48-21.65), was changed TAR by -15.90% (95% CI -21.44 to -10.36), was changed HbA1c by -1.27% (95% CI -2.06 to -0.48), and changed mean glucose by -21.34 mg/dL (95% CI -32.06 to -10.62) or 1.19 mmol/L (95% CI -1.78 to -0.59). There was a modest yet significant reduction in TBR. There were no changes in body weight or BMI.
Heterogeneous study designs, including only three randomized controlled trials, and imputed missing data.
AID systems improved glucose control in a diverse population of individuals with type 2 diabetes requiring insulin therapy with reduction in hypoglycemia. These findings support recommendations for AID systems use in future type 2 diabetes management guidelines.