Long-term effectiveness of automated insulin delivery in young people with type 1 diabetes: a meta-analysis

Abstract

Abstract

To evaluate the long-term glycemic outcomes of automated insulin delivery (AID) systems in young people (age ≤ 25 years) with type 1 diabetes. We searched PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to October 25, 2025. Clinical trials and real-world studies with intervention periods of ≥ 12 months were included. The primary outcomes were changes in time in range (TIR, 3.9–10.0 mmol/L) and HbA1c. Secondary outcomes included time in tight range (TITR, 3.9–7.8 mmol/L), time below/above range metrics (TBR1 10.0 mmol/L; TAR2 > 13.9 mmol/L), mean sensor glucose, glucose coefficient of variation (CV), and glucose standard deviation (SD). Data were pooled using random-effects models to calculate mean differences (MDs) with 95% confidence intervals (CIs). A total of 26 studies involving 16,596 participants were included. The use of AID systems significantly increased TIR by 11.56% (MD 11.56%, 95% CI 10.20 to 12.93; p < 0.001), equivalent to 166 additional minutes per day, and reduced HbA1c by 0.52% (MD: -0.52%; 95% CI: -0.63 to -0.40; p < 0.001). AID systems significantly increased TITR by 9.11% (MD 9.11%, 95% CI 7.59 to 10.63; p < 0.001). Significant reductions were also observed in TBR1 (MD -0.69%, 95% CI -1.33 to -0.06), TBR2 (MD -0.31%, 95% CI -0.54 to -0.08), TAR1 (MD -9.87%, 95% CI -11.56 to -8.17), and TAR2 (MD -5.21%, 95% CI -6.39 to -4.03). Mean sensor glucose decreased by 15.05 mg/dL (95% CI -17.99 to -12.11). Glucose CV was reduced by 0.99% (MD -0.99%, 95% CI -1.76 to -0.21) and glucose SD decreased by 5.80 mg/dL (MD -5.80 mg/dL, 95% CI -7.00 to -4.59). AID systems provide substantial and sustained improvements in glycemic control over ≥ 12 months in young people with type 1 diabetes, supporting their long-term clinical implementation. This study was registered on PROSPERO (CRD420251150271).