Does fully closed-loop automated insulin delivery improve glycaemic control in patients with type 2 diabetes? A meta-analysis of randomized controlled trials

AimsThis meta-analysis investigated the efficacy and safety of fully closed-loop automated insulin delivery (AID) in patients with type 2 diabetes. Materials and MethodsWe systemically searched PubMed, Scopus, Web of Science, and Cochrane Central from inception until April 26, 2023. We included randomized controlled trials (RCTs) comparing fully closed-loop AID versus conventional insulin therapy. The outcomes were pooled as Hedges' g and risk ratio with 95% confidence interval (CI) in the random effect model. Our primary outcome was the proportion of time in the target glucose range (5.6-10 mmol/L, 3.9-10 mmol/L, or 3.9-8 mmol/L, depending on the study). Key secondary outcomes included the proportion of time spent in hyperglycaemia or hypoglycaemia. ResultsWe included seven RCTs (three crossover and one parallel design), compromising 390 patients. Our analysis showed that compared to the control group, fully closed-loop AID increased the proportion of time spent within the target glucose range by additional 18 min per 24 h (Hedges' g = 1.22%, 95% CI [0.84%, 1.6%], p < 0.01), additional 5 min overnight (Hedges' g = 0.99%, 95% CI [0.65%, 1.33%], p < 0.01), and additional 13 min during the daytime period (Hedges' g = 1.36%, 95% CI [1.1%, 1.61%], p < 0.01). Compared to the control group, the overall time in hyperglycaemia was shortened by 15 min per 24 h (Hedges' g = -1.04%, 95% CI [-1.43%, -0.64%], p < 0.01). There was no significant difference between the two groups in terms of overall, overnight, and daytime periods spent in hypoglycaemia. ConclusionsOur meta-analysis suggests that fully closed-loop AID may improve glycaemic control in patients with type 2 diabetes, particularly for those with more challenging diabetes management. Further research is required to establish the feasibility of implementing these systems in clinical practice.