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Article Abstract
Aims: The landscape of insulin delivery is evolving, transitioning from hybrid automated insulin delivery (AID) to more sophisticated fully AID systems. We aimed to compare the efficacy of fully AID systems with any insulin delivery method in type 1 diabetes (T1D).
Materials And Methods: Following registration in PROSPERO, CRD42024528669, PubMed, Embase, Cochrane Library and Web of Science were searched up to 26 February 2025 for randomised clinical trials comparing fully AID systems to any insulin delivery method in T1D. The control treatments included conventional insulin therapy (multiple daily injections, continuous subcutaneous insulin infusion and sensor-augmented pumps) and hybrid AID systems. The primary outcome was the mean difference (MD) in the percentage of time blood glucose concentration remained in the target range (3.9-10.0 mmol/L or 4.0-10.0 mmol/L), assessed by random-effects models.
Results: We identified 1308 reports; after exclusions, 16 trials (669 patients) were included. Time in range (TIR) was higher using fully AID systems than control treatments (MD 9.99% [95% confidence interval, 3.75% to 16.22%], p = 0.002). This improvement was accompanied by increased diabetes treatment satisfaction (MD 3.70 points [95% confidence interval, 0.22 points to 7.18 points], p = 0.04). Fully AID systems exhibited a favourable effect on TIR when compared with conventional insulin therapy, while exhibiting an opposite effect when compared with hybrid AID (17.44% vs. -3.05%, p < 0.001). Younger patients with T1D, as well as patients with a shorter diabetes duration, exhibited more significant glycaemic improvements with fully AID systems therapy.
Conclusions: Fully AID systems improved glycaemic control and diabetes treatment satisfaction compared with other non-AID methods in patients with T1D, especially for younger patients. However, to achieve or exceed the desired benefits of hybrid AID, algorithm upgradation, along with the synergistic integration of multiple hormones, will be crucial for next-generation fully AID systems.
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