TOPLINE:

Compared with standard insulin regimens, automated insulin delivery (AID) systems used for 6 months or longer were associated with better glycemic control — including increased time in range and lower A1c levels — without an increased risk for adverse events in youth aged 6-18 years with type 1 diabetes (T1D). Certain benefits were particularly notable during nighttime.

METHODOLOGY:

• Although youth with T1D are increasingly using AID systems to manage blood glucose, few systematic reviews of randomized clinical trials are available to guide decision-making.
• Researchers conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy and safety of prolonged AID use (> 48 hours) for glucose management in outpatient settings among youth aged 6-18 years with T1D.
• They included 11 unique trials with 901 patients (median age, 12 years; 51% girls; median duration of diabetes, 6.1 years) who were randomly assigned to an AID system or a standard insulin regimen such as sensor-augmented pump therapy or multiple daily injections with or without continuous glucose monitoring for a median duration of 31 weeks.
• Primary outcomes were mean time in range (percentage of time with glucose levels > 3.9 to < 10 mmol/L) and mean A1c levels, and secondary outcomes included mean time in hypoglycemia (≤ 3.9 mmol/L) and hyperglycemia (≥ 10 mmol/L) during daytime and nighttime.

TAKEAWAY:

• In a meta-analysis of the 10 trials that included measurements of time in range, (n = 786 patients), AID systems increased time in range by an average of 11.5% (95% CI, 9.3%-13.7%) compared with standard insulin regimens.
• In an analysis of all 11 trials (n = 901 patients), youth using AID systems had an average reduction of 0.41% in A1c levels (95% CI, -0.58% to -0.25%) compared with those using standard insulin regimens.
• Improvements in time in range were more pronounced at night than during the day, with time in range increasing by 19.7% overnight (95% CI, 17.0%-22.4%; n = 588 from seven trials) compared with 8.5% during daytime (95% CI, 5.9%-11.1%; n = 518 from six trials). AID systems were also linked to reduced time in both hypoglycemia and hyperglycemia, with the effect for both being greater at night than during the day.
• No difference was observed in the overall rates of adverse events between groups.

IN PRACTICE:

“The certainty of the evidence for the association of AID with measures of glucose management was generally high, suggesting that these data could inform future clinical practice guidelines,” the authors wrote.

SOURCE:

The study was led by Hannah Steiman de Visser, Diabetes Research Envisioned and Accomplished in Manitoba Research Theme, Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada. It was published online in JAMA Pediatrics.

LIMITATIONS:

The lack of racial and socioeconomic diversity among participants reduced external validity, with Asian, Black, Hispanic, and Indigenous youth particularly underrepresented.

DISCLOSURES:

This study was supported by the Canadian Institutes of Health Research and Breakthrough Diabetes (formerly Juvenile Diabetes Research Foundation). One author disclosed receiving advisory board fees from Novo Nordisk Canada and Dexcom unrelated to the submitted work. Another author reported receiving devices from Abbott at no cost for a separate clinical investigation.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.