Closed-Loop Insulin Delivery in Inpatient Care: A Systematic Review and Meta-Analysis of Clinical and Implementation Outcomes
In brief
Closed-loop insulin raises hospitalized adults' time in range by 22 points
Across 13 inpatient studies, closed-loop insulin delivery increased time in range by about 22 percentage points and lowered average glucose; nine studies contributed to the pooled analysis. No serious device-related adverse events were reported, but effects on hospital stay and comparative safety remain uncertain, and staff training, technical support, and workflow integration may limit wider use.
- Journal
- Diabetes, obesity & metabolism (Q1)
- Published
- 3 November 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Vaynika Gupta, Amanda Ling Jie Yee, Eleni Armeni, Kalyaani Persad, Aspasia Manta, Punith Kempegowda
- PMID
- 42977540
- DOI
- 10.1111/dom.71498
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 5 November 2026): Systematic review evaluates inpatient insulin delivery and glycaemic outcomes
Abstract
AIMS: Closed-loop (CL) insulin delivery systems have transformed outpatient diabetes care. However, evidence supporting their role in inpatient settings is limited. This systematic review and meta-analysis evaluated the safety, efficacy, and implementation of CL systems in inpatient care. MATERIALS AND METHODS: This review followed PRISMA guidelines (PROSPERO: CRD420251133486). Eligible studies reported glycaemic, safety, and/or implementation outcomes for adults managed with CL systems in inpatient care. EMBASE, PubMed, MEDLINE, Scopus, CINAHL, and Cochrane Library were searched from inception to August 2026. Risk of bias was assessed using RoB2 and ROBINS-I. Random-effects meta-analysis evaluated glycaemic outcomes and length of stay (LOS). Results were presented as pooled mean differences (MDs) and 95% confidence intervals (CIs). Implementation data were analysed thematically. Intrapartum outcomes were analysed separately. RESULTS: Thirteen inpatient studies were included, nine contributing to meta-analysis. CL delivery increased time in range (MD +22.27%, 95% CI: 16.03-28.51; p < 0.001) and reduced time above range (MD -23.75%, 95% CI: -28.05 to -19.45; p < 0.001), mean glucose (MD -1.66 mmol/L, 95% CI: -2.29 to -1.03; p < 0.001) and glucose standard deviation (MD -0.64 mmol/L, 95% CI: -0.85 to -0.43; p < 0.001). No significant differences were observed in time below range, coefficient of variation or LOS. Total daily insulin dose was higher (MD +10.82 IU/day, 95% CI: 0.02-21.62; p = 0.05). No serious device-attributed adverse events were reported. Implementation challenges included staff training, technical support, and workflow integration. Four additional intrapartum studies were included; two contributed to the meta-analysis, showing increased pregnancy-specific time in range (MD +11.82%, 95% CI: 5.56-18.08; p < 0.001). CONCLUSION: CL systems improve inpatient glycaemic control, although effects on LOS and comparative safety remain uncertain. Wider adoption requires sustainable technical and organisational support.
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.