A landmark meta-analysis led by researchers at the German Diabetes Center (DDZ) has confirmed that automated insulin delivery (AID) systems significantly improve blood glucose management in individuals with type 1 diabetes compared to conventional insulin therapies. Published in eClinicalMedicine, the study represents the most extensive analysis of its kind, reviewing data from 46 clinical trials involving a total of 4,113 participants.
The research examined three major AID technologies—Hybrid Closed-Loop (HCL), Advanced Hybrid Closed-Loop (AHCL), and Full Closed-Loop (FCL) systems—often referred to collectively as artificial pancreas systems. These systems integrate continuous glucose monitoring with algorithm-driven insulin pumps that adjust insulin dosages in real time based on blood glucose levels.
Key Findings: Enhanced Glycemic Control
The study’s findings highlight a clear advantage of AID systems in maintaining blood glucose within target ranges. Notably, AHCL systems—currently the most widely used in Germany—demonstrated an average increase of 24% in time spent within the target glucose range compared to standard pump therapy.
In addition to greater time in range, AHCL systems also substantially reduced periods of hyperglycemia, including both moderately high (>180 mg/dL) and severely high (>250 mg/dL) glucose levels. The systems were associated with improvements in HbA1c values, a long-term indicator of blood sugar control.
However, the analysis found only modest improvements in reducing episodes of hypoglycemia, particularly those involving critically low glucose levels (<70 mg/dL and <54 mg/dL). The researchers emphasized the need for further investigation to better understand and enhance performance in this area.
Clinical Implications
“This study provides crucial evidence for clinicians and patients when selecting the most effective therapy,” said Prof. Dr. Michael Roden, Scientific Managing Director of the DDZ and Director of the Clinic for Endocrinology and Diabetology at the University Hospital of Düsseldorf.
“AID systems show clear advantages, but not all clinical targets are equally affected,” added Dr. Anna Stahl-Pehe, the study’s lead author. “Ongoing research is essential to refine and improve these technologies.”
As the use of AID systems continues to grow, particularly in countries like Germany, this meta-analysis reinforces their role in advancing personalized, technology-driven diabetes care while also pointing to areas where further development is needed.
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