Automated glycemic control with a bionic pancreas for type 1 diabetes mellitus: A systematic review and meta-analysis

Background and aims: The use of a bionic pancreas with automated insulin delivery systems to prevent complications of diabetes mellitus shows conflicting results. We aimed to comprehensively discuss the potential use of a bionic pancreas in patients with type 1 diabetes (T1D).Methods: A systematic database search was conducted on October 24, 2022, for articles investigating the use of a bionic pancreas in patients with T1D. The hemoglobin A1c (HbA1c) level, mean glucose level, glucose coefficient of variability, time-in-range (TIR), and adverse events were investigated.Results: Nine studies were included in this review. The data from these studies suggested that the use of a bionic pancreas could reduce the HbA1c (mean difference [MD] =-0.40% [95% confidence interval {CI} =-0.59 to-0.21], I-2 = 0%, p < 0.0001) and mean glucose levels (MD =-21.06 [95% CI =-24.66 to-17.46], I-2 = 45%, p < 0.00001) and improve the TIR (MD = 14.41% [95% CI = 10.99 to 17.83], I-2 = 60%, p < 0.00001). The most common adverse events reported were nausea and vomiting.Conclusions: The use of a bionic pancreas shows potential in preventing complications of T1D by improving the TIR and decreasing the HbA1c and mean glucose levels. Furthermore, serious adverse events with the use of a bionic pancreas and standard of care show insignificant results, suggesting a good safety profile.