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Background <p>To evaluate the long-term glycemic outcomes of automated insulin delivery (AID) systems in young people (age ≤ 25 years) with type 1 diabetes.</p> Methods <p>We searched PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to October 25, 2025. Clinical trials and real-world studies with intervention periods of ≥ 12 months were included. The primary outcomes were changes in time in range (TIR, 3.9–10.0 mmol/L) and HbA<sub>1c</sub>. Secondary outcomes included time in tight range (TITR, 3.9–7.8 mmol/L), time below/above range metrics (TBR1 &lt; 3.9 mmol/L; TBR2 &lt; 3.0 mmol/L; TAR1 &gt; 10.0 mmol/L; TAR2 &gt; 13.9 mmol/L), mean sensor glucose, glucose coefficient of variation (CV), and glucose standard deviation (SD). Data were pooled using random-effects models to calculate mean differences (MDs) with 95% confidence intervals (CIs).</p> Results <p>A total of 26 studies involving 16,596 participants were included. The use of AID systems significantly increased TIR by 11.56% (MD 11.56%, 95% CI 10.20 to 12.93; <i>p</i> &lt; 0.001), equivalent to 166 additional minutes per day, and reduced HbA<sub>1c</sub> by 0.52% (MD: -0.52%; 95% CI: -0.63 to -0.40; <i>p</i> &lt; 0.001). AID systems significantly increased TITR by 9.11% (MD 9.11%, 95% CI 7.59 to 10.63; <i>p</i> &lt; 0.001). Significant reductions were also observed in TBR1 (MD -0.69%, 95% CI -1.33 to -0.06), TBR2 (MD -0.31%, 95% CI -0.54 to -0.08), TAR1 (MD -9.87%, 95% CI -11.56 to -8.17), and TAR2 (MD -5.21%, 95% CI -6.39 to -4.03). Mean sensor glucose decreased by 15.05&#xa0;mg/dL (95% CI -17.99 to -12.11). Glucose CV was reduced by 0.99% (MD -0.99%, 95% CI -1.76 to -0.21) and glucose SD decreased by 5.80&#xa0;mg/dL (MD -5.80&#xa0;mg/dL, 95% CI -7.00 to -4.59).</p> Conclusions <p>AID systems provide substantial and sustained improvements in glycemic control over ≥ 12 months in young people with type 1 diabetes, supporting their long-term clinical implementation.</p> Trial registration <p>This study was registered on PROSPERO (CRD420251150271).</p>

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Long-term effectiveness of automated insulin delivery in young people with type 1 diabetes: a meta-analysis

  • 期刊论文

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  • 发表日期：

    2026年5月25日

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  • Zhihui Sun,
  • Sihan Yang,
  • Le Gao,
  • Lin Dou,
  • Baoqi Zeng

摘要

Background

To evaluate the long-term glycemic outcomes of automated insulin delivery (AID) systems in young people (age ≤ 25 years) with type 1 diabetes.

Methods

We searched PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to October 25, 2025. Clinical trials and real-world studies with intervention periods of ≥ 12 months were included. The primary outcomes were changes in time in range (TIR, 3.9–10.0 mmol/L) and HbA1c. Secondary outcomes included time in tight range (TITR, 3.9–7.8 mmol/L), time below/above range metrics (TBR1 < 3.9 mmol/L; TBR2 < 3.0 mmol/L; TAR1 > 10.0 mmol/L; TAR2 > 13.9 mmol/L), mean sensor glucose, glucose coefficient of variation (CV), and glucose standard deviation (SD). Data were pooled using random-effects models to calculate mean differences (MDs) with 95% confidence intervals (CIs).

Results

A total of 26 studies involving 16,596 participants were included. The use of AID systems significantly increased TIR by 11.56% (MD 11.56%, 95% CI 10.20 to 12.93; p < 0.001), equivalent to 166 additional minutes per day, and reduced HbA1c by 0.52% (MD: -0.52%; 95% CI: -0.63 to -0.40; p < 0.001). AID systems significantly increased TITR by 9.11% (MD 9.11%, 95% CI 7.59 to 10.63; p < 0.001). Significant reductions were also observed in TBR1 (MD -0.69%, 95% CI -1.33 to -0.06), TBR2 (MD -0.31%, 95% CI -0.54 to -0.08), TAR1 (MD -9.87%, 95% CI -11.56 to -8.17), and TAR2 (MD -5.21%, 95% CI -6.39 to -4.03). Mean sensor glucose decreased by 15.05 mg/dL (95% CI -17.99 to -12.11). Glucose CV was reduced by 0.99% (MD -0.99%, 95% CI -1.76 to -0.21) and glucose SD decreased by 5.80 mg/dL (MD -5.80 mg/dL, 95% CI -7.00 to -4.59).

Conclusions

AID systems provide substantial and sustained improvements in glycemic control over ≥ 12 months in young people with type 1 diabetes, supporting their long-term clinical implementation.

Trial registration

This study was registered on PROSPERO (CRD420251150271).