Glycemic and psychosocial outcomes of automated insulin delivery in older and high-risk populations with type 1 diabetes: a systematic review and meta-analysis
In brief
Automated insulin delivery adds 2.7 hours in range daily for high-risk adults
Across 23 studies involving 967 people with type 1 diabetes, automated insulin delivery increased time in the target glucose range by about 2.7 hours per day and reduced time spent both high and low. The evidence was rated very low certainty; psychosocial scores and rates of severe hypoglycemia or diabetic ketoacidosis did not significantly change.
- Journal
- The Journal of clinical endocrinology and metabolism (Q1)
- Published
- 30 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Puguh Oktavian, Citrawati Dyah Kencono Wungu, Indah Mohd Amin, Sony Wibisono Mudjanarko
- PMID
- 42810730
- DOI
- 10.1210/clinem/dgag344
Why clinicians should know about it
- Picked for Biochemistry (medical) (paper of the day, 2 October 2026): Automated insulin delivery outcomes in T1D
Abstract
BACKGROUND: Automated insulin delivery (AID) has revolutionized care for people with type 1 diabetes. However, its efficacy and safety in older adults (≥60 years) and high-risk populations, including those with impaired awareness of hypoglycemia, or cognitive or functional impairment, have not been systematically evaluated. MATERIALS AND METHODS: CENTRAL, PubMed, Web of Science, Scopus, and ClinicalTrials.gov from inception to March 10, 2026. Studies on automated insulin delivery in older and high-risk individuals with type 1 diabetes were included. The primary outcome was time in range (3.9-10.0 mmol/L [70-180 mg/dL]). Secondary outcomes included time above range, time below range, psychosocial well-being (Gold, Clarke, and Hypoglycemia Fear Survey score), and serious adverse events. Pooled effect sizes were estimated with random-effects models (PROSPERO, CRD420251273526). RESULTS: Twenty-three studies involving 967 participants (11 randomized controlled trials, 3 single-arm, and 9 cohort studies) were included. Automated insulin delivery increased time in range by 11.38% (95% CI: 8.07-14.70; I2 = 70%; P < .0001; very low certainty; equivalent to 2.7 hours/day). Time in range improvement was observed during the day (8.70%; 95% CI 5.18-12.22%) and overnight (13.35%; 95% CI 11.07-15.62%). Favorable improvement was also comparable among commercial and noncommercial systems. Automated insulin delivery reduced the time spent in hyperglycemia (-7.89%) and hypoglycemia (-1.16%). No significant differences in psychosocial well-being were observed. Diabetic ketoacidosis and severe hypoglycemia events were not significant. CONCLUSION: Automated insulin delivery exhibits favorable glycemic outcomes and safety profiles in older and high-risk individuals with type 1 diabetes, suggesting potential benefits for populations traditionally considered vulnerable, although no significant improvements were observed in psychosocial outcomes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.