Critical Insights into the Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus (Diabetes Metab J 2025;49:235-51)

Sami Ullah; Ayesha Ahmad; Kamil Ahmad Kamil; Minahil Laraib Asif; Abdullah Jan

doi:10.4093/dmj.2025.0243

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Letter Critical Insights into the Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus (Diabetes Metab J 2025;49:235-51): Sami Ullah¹, Ayesha Ahmad², Kamil Ahmad Kamil³, Minahil Laraib Asif⁴, Abdullah Jan¹; Diabetes & Metabolism Journal 2025;49(3):516-517.
DOI: https://doi.org/10.4093/dmj.2025.0243
Published online: May 1, 2025

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¹Saidu Medical College Swat, Saidu Sharif, Pakistan

²Khyber Medical University, Peshawar, Pakistan

³Department of Internal Medicine, Mirwais Regional Hospital, Shahr-e Naw, Kandahar, Afghanistan

⁴Karachi Medical and Dental College, Karachi, Pakistan

Corresponding author: Kamil Ahmad Kamil

Department of Internal Medicine, Mirwais Regional Hospital, Shahre-Naw, 3801, Kandahar, Afghanistan E-mail: drkamilahmad1@gmail.com

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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See the reply "Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis (Diabetes Metab J 2025;49:235-51)" in Volume 49 on page 520.

See the article "Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis" on page 235.

We read the study titled ‘Efficacy and safety of automated insulin delivery systems in patients with type 1 diabetes mellitus: a systematic review and meta-analysis’ by Fan et al. [1] in the Diabetes and Metabolism Journal with great interest and commend the authors for their remarkable insights into the efficacy and safety of automated insulin delivery (AID) systems [1]. The authors have perfectly depicted the potential of AID systems in enhancing glycemic control while not increasing the risk of severe hypoglycemia significantly. Moreover, the incorporation of diverse patient populations has significantly contributed to a better knowledge of the AID system’s clinical efficiency. Although the study provides valuable findings, certain aspects could be considered for evaluation.

Firstly, while the author has mentioned valuable information about AID systems, the statistical irregularity that comes up from significant heterogeneity in study designs, sample sizes, and population characteristics increases the risk of bias and limits the general use of findings. This variability makes the metaanalytical synthesis more challenging and reduces the statistical power to make strong judgments regarding the efficacy and safety of different AID systems across pediatric, adult, and geriatric populations. A study by Zeng et al. [2] demonstrates that AID systems outperform conventional insulin therapy in managing type 1 diabetes mellitus (T1DM) among children and adolescents in outpatient settings, demonstrating consistent shortand long-term benefits. Therefore, for a better understanding of AID system efficacy, deep subgroup analyses based on different populations and characteristics, such as type of AID system, baseline glycosylated hemoglobin (HbA1c), age, and duration of T1DM, can be taken into notice. Secondly, the researchers could have done the cost-effectiveness analysis of AID systems, which is a crucial aspect of healthcare systems, thus making the AID system’s accessibility uncomplicated for low- and middle-income countries. Prior research by Boughton and Hovorka [3] highlights that the addition of glucagon improves the dual-hormone system’s ability to replicate pancreatic islet physiology, but it also raises the system’s complexity and cost. Additionally, although the author has completely evaluated the impact of the AID system while focusing on clinical benefits like HbA1c, time in range, and hypoglycemia, the effect of the AID system can be deeply studied on the personal lives of the patients, such as the quality of life, diabetes burden, and psychological well-being. According to Boughton and Hovorka [3], AID systems enhance sleep, raise confidence, and lessen hypoglycemic anxiety while improving glycemic management.

However, customers encounter obstacles such as problems with trust, annoying alerts, technological issues, and concerns about device size, thus causing anxiety due to over-reliance on technology. Besides, Kahkoska et al. [4] demonstrate that closedloop systems may affect eating habits, possibly changing dietary patterns in individuals with T1DM, thus affecting patients’ wellbeing. Considering these limitations, a detailed analysis can be considered in future studies of how the AID system impacts patients’ personal lives, psychological well-being, and diabetes distress. Moreover, there is another room for improvement in future research for the evaluation of the efficacy and safety of the AID system in special populations such as pregnant women, older adults, children, and those with underlying comorbidities, which might undermine the true estimate of the AID system’s efficacy. According to Boughton and Hovorka [3], women with T1DM who use AID systems throughout pregnancy are less likely to experience macrosomia, premature delivery, stillbirth, and neonatal death. Besides, Beck et al. [5] also highlight the efficacy of insulin pump therapy in newly diagnosed diabetes cases in children, while also revealing great interest in continuous glucose monitors for hospitalized diabetic patients and critically ill non-diabetic patients, thus providing extensive insights into AID system’s efficacy in special populations.

While the study offers valuable insights into the efficacy of AID systems, certain limitations, such as heterogeneity in the study population, high cost of AID systems, and evaluation of patient-centered outcomes, should be addressed. Besides, the expansion of the study to evaluate the efficacy of the AID system across special populations such as pregnant women or newly diagnosed cases of children with diabetes should be taken into account. Future studies should take care of these aspects to enhance the generalizability and clinical applicability of AID systems.

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CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

REFERENCES

1. Fan W, Deng C, Xu R, Liu Z, Leslie RD, Zhou Z, et al. Efficacy and safety of automated insulin delivery systems in patients with type 1 diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab J 2025;49:235-51.Article PubMed PDF
2. Zeng B, Gao L, Yang Q, Jia H, Sun F. Automated insulin delivery systems in children and adolescents with type 1 diabetes: a systematic review and meta-analysis of outpatient randomized controlled trials. Diabetes Care 2023;46:2300-7.Article PubMed PMC PDF
3. Boughton CK, Hovorka R. Automated insulin delivery in adults. Endocrinol Metab Clin North Am 2020;49:167-78.Article PubMed
4. Kahkoska AR, Mayer-Davis EJ, Hood KK, Maahs DM, Burger KS. Behavioural implications of traditional treatment and closed-loop automated insulin delivery systems in type 1 diabetes: applying a cognitive restraint theory framework. Diabet Med 2017;34:1500-7.Article PubMed PMC PDF
5. Beck RW, Bergenstal RM, Laffel LM, Pickup JC. Advances in technology for management of type 1 diabetes. Lancet 2019;394:1265-73.Article PubMed

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Critical Insights into the Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus (Diabetes Metab J 2025;49:235-51)

Diabetes Metab J. 2025;49(3):516-517. Published online May 1, 2025

DOI: https://doi.org/10.4093/dmj.2025.0243

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Critical Insights into the Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus (Diabetes Metab J 2025;49:235-51)

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Ullah S, Ahmad A, Kamil KA, Asif ML, Jan A. Critical Insights into the Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus (Diabetes Metab J 2025;49:235-51). Diabetes Metab J. 2025;49(3):516-517.

DOI: https://doi.org/10.4093/dmj.2025.0243.

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