Automated insulin delivery systems in children and adolescents with type 1 diabetes: a systematic review and meta-analysis of outpatient randomised controlled trials

  

The glycemic control of automated insulin delivery (AID) systems in outpatient children and adolescents with type 1 diabetes (T1D) has not been systematically evaluated.

PURPOSE

To evaluate the efficacy and safety of AID systems in children and adolescents in outpatient settings.

DATA SOURCES

PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched until 4 May 2023. 

STUDY SELECTION

We included randomised controlled trials that compared AID systems with conventional insulin therapy in outpatient children and adolescents with T1D and reported continuous glucose monitoring outcomes. 

DATA EXTRACTION

Percent time in range (TIR, 3.9–10 mmol/L), time below range (TBR, <3.9 mmol/L), and time above range (TAR, >10 mmol/L) were extracted. Data were summarised as mean differences (MDs) with 95% CI.

DATA SYNTHESIS

25 trials (1345 participants) were included in the meta-analysis. Automated insulin delivery systems were associated with an increased percentage of TIR (11.38%, 9.01 to 13.76, p<0.001; high certainty). The favourable effect was consistent whether AID was used over three months (10.46%, 8.71 to 12.20) or six months (10.87%, 7.11 to 14.63). AID systems had a favourable effect on the proportion of TBR (–0.59%, –1.02 to –0.15, p=0.008; low certainty) or TAR (–12.19%, –14.65 to –9.73, p<0.001; high certainty), compared with control treatment.

LIMITATIONS

Substantial heterogeneity was observed in most analysis.

CONCLUSIONS

AID systems are more effective than conventional insulin therapy for children and adolescents with T1D in outpatient settings. The favourable effect is consistent both in short-term and long-term.