Automated Insulin Delivery Systems in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis

BACKGROUND: Automated insulin delivery (AID) systems are the standard of care in type 1 diabetes. Recent studies suggest benefits of these systems for people with type 2 diabetes, as well. PURPOSE: To evaluate the effects of AID systems on glycemic outcomes in people with type 2 diabetes requiring insulin. DATA SOURCES: The PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched through 10 March 2025. This study was registered with PROSPERO (CRD420251036184). STUDY SELECTION: Nine studies (n = 1,530 participants) were included that evaluated AID systems in people with type 2 diabetes reporting continuous glucose monitoring outcomes. DATA EXTRACTION: Data were collected on study characteristics and outcomes including time in range (TIR) (3.9-10.0 mmol/L [70-180 mg/dL]), time above range (TAR) (>10.0 mmol/L [>180 mg/dL]), time below range (TBR) (<3.9 mmol/L [<70 mg/dL]), mean glucose, and HbA1c. We performed a single-arm meta-analysis using a random-effects model. DATA SYNTHESIS: AID systems significantly increased TIR by 16.06% (95% CI 10.48-21.65), was changed TAR by -15.90% (95% CI -21.44 to -10.36), was changed HbA1c by -1.27% (95% CI -2.06 to -0.48), and changed mean glucose by -21.34 mg/dL (95% CI -32.06 to -10.62) or 1.19 mmol/L (95% CI -1.78 to -0.59). There was a modest yet significant reduction in TBR. There were no changes in body weight or BMI. LIMITATIONS: Heterogeneous study designs, including only three randomized controlled trials, and imputed missing data. CONCLUSIONS: AID systems improved glucose control in a diverse population of individuals with type 2 diabetes requiring insulin therapy with reduction in hypoglycemia. These findings support recommendations for AID systems use in future type 2 diabetes management guidelines.