Practical tips for the use of automated insulin delivery systems in individuals with diabetes during minor procedures performed under sedation or anesthesia and during labor

INTRODUCTION: Automated insulin delivery (AID) systems have become a standard of care in type 1 diabetes and are increasingly used across all age groups, including during pregnancy. As their use expands, clinicians are increasingly encountering patients using AID systems in perioperative and peripartum settings. However, guidance regarding continuation of AID therapy during procedures under anesthesia, sedation, or during labor remains limited. OBJECTIVES: This document provides practical, consensus-based recommendations for the use of AID systems during minor procedures, selected major surgeries, and throughout labor and delivery, aiming to support anesthesiologists, surgeons, and other procedural specialists, obstetric teams, and diabetes specialists in clinical decision-making. METHODS: Eleven experts in pediatric and adult diabetology, each with extensive clinical experience in managing AID users in outpatient and inpatient settings, conducted a comprehensive literature review and synthesized available evidence with collective clinical experience. RESULTS: The authors outline criteria for continuation of AID therapy during procedures, including requirements related to the patient, procedural team, and type of procedure. Detailed perioperative algorithms are provided. Recommendations for labor emphasize adjustments of AID parameters, glucose targets, and postpartum modifications. While AID continuation may be appropriate for many minor procedures and selected major surgeries, intravenous insulin therapy remains preferable in situations associated with hemodynamic instability or high metabolic risk. CONCLUSIONS: With appropriate preparation and interdisciplinary coordination, continuation of AID therapy during selected procedures and childbirth can be safe and effective, reducing glycemic variability and treatment burden. As evidence remains limited, further clinical studies are urgently needed to validate and refine these recommendations.