Beyond Metabolic Control: Psychosocial Benefits of Automated Insulin Delivery Systems in Pediatric Type 1 Diabetes, a Systematic Review

Introduction: Type 1 diabetes (T1D) affects approximately 1.2 million children and adolescents worldwide. Despite advances in therapy, insulin remains the primary treatment, requiring tight glycemic control to prevent long-term complications. Automated insulin delivery (AID) systems, combining continuous glucose monitoring and insulin pumps with algorithms, have opened a new paradigm in T1D management. This review aims to synthesize data on psychosocial outcomes and quality of life (QoL) from randomized controlled trials (RCTs) comparing AID systems to standard diabetes care in children and adolescents. Methods: A systematic search following PRISMA guidelines was conducted across Medline, Embase, PubMed, and Cochrane databases. RCTs evaluating QoL of children with T1D using AID systems were included. Data extracted included participant demographics, AID system types, main outcomes, QoL scales, and results. Studies had to involve children and/or adolescents with T1D using AID systems and/or their caregivers and assess QoL or psychosocial outcomes using validated scales. Results: The search identified 3373 studies, with 14 meeting inclusion criteria, encompassing 1251 participants, mostly children, adolescents and young adults. Studies used various AID systems, including Control-IQ, CamAPS FX, Diabeloop DBL4K, Medtronic MiniMed ® 670G and Advanced Hybrid Closed-Loop, and compared them to standard care. They showed variable improvements in treatment satisfaction and expectations, sleep quality, and QoL, along with a reduction in fear of hypoglycemia when using AID systems. However, the effect on emotional burden and diabetes distress was inconsistent. Conclusions: RCTs indicate that AID systems enhance treatment satisfaction, sleep quality, and hypoglycemia confidence in children with T1D, contributing to better diabetes-specific QoL. Although their impact on emotional burden and diabetes distress outcomes is inconsistent, AID systems generally offer significant benefits over traditional insulin delivery methods, underscoring their importance in pediatric T1D management.