Type 1 diabetes and AID systems: meta-analysis proves efficacy

In a recently published study, researchers at the German Diabetes Center (DDZ) showed that automated insulin delivery (AID) systems can improve blood glucose control in people with type 1 diabetes compared to other insulin therapies. The systematic review analyzed 46 clinical studies with a total of 4,113 participants, making it the most comprehensive study of its kind to date.

The analysis focused on Hybrid Closed-Loop (HCL), Advanced Hybrid Closed-Loop (AHCL) and Full Closed-Loop (FCL) systems, also known as artificial pancreas systems. The devices combine continuous glucose measurement with automatic insulin delivery and adjust insulin administration to the glucose level in real time.

As the DDZ study shows, the AID systems increased the time in the target range compared to conventional pump therapy. For AHCL systems, which are currently the most common AID systems in Germany, the average increase was 24%. At the same time, AHCL systems reduced the time with elevated glucose values (>180 mg/dl) as well as with severely elevated values (>250 mg/dl) compared to conventional pump therapy. The HbA1c value also improved when AHCL systems were used. These results clearly indicate a benefit, even if future studies might change the assessment slightly. For the period with very low glucose levels (<70 and <54 mg/dl), however, only a low efficacy was found. Further studies are needed to better assess the effect.

Significance for Practice

“This study provides data for clinical decision making and the joint selection of therapy between affected persons and attending physicians,” explains Prof. Dr. Michael Roden, Scientific Managing Director and Spokesman of the Board of the DDZ and Director of the Clinic for Endocrinology and Diabetology at the University Hospital of Düsseldorf (UKD).

“AID systems offer overall advantages, but these are not equally pronounced for all target variables. Extensive research is still being carried out to optimize AID systems,” adds Dr. Anna Stahl-Pehe, first author of the study.

Original publication:
Stahl-Pehe A, Shokri-Mashhadi N, Wirth M, Schlesinger S, Kuss O, Holl RW, Bächle C, Warz K-D, Bürger-Büsing J, Spörkel O, Rosenbauer J. 2025. Efficacy of automated insulin delivery systems in people with type 1 diabetes: a systematic review and network meta-analysis of outpatient randomised controlled trials. eClinicalMedicine. 82:103190. https://doi.org/10.1016/j.eclinm.2025.103190

The study was funded by the Federal Ministry of Education and Research (funding code 01KG2203).

The German Diabetes Center (DDZ) serves as the German reference center for diabetes. Its objective is to contribute to the improvement of prevention, early detection, diagnosis and treatment of diabetes mellitus. At the same time, the research center aims at improving the epidemiological data situation in Germany. The DDZ coordinates the multicenter German Diabetes Study and is a point of contact for all players in the health sector. In addition, it prepares scientific information on diabetes mellitus and makes it available to the public. The DDZ is part of the Leibniz Association (Wissenschaftsgemeinschaft Gottfried Wilhelm Leibniz, WGL) and is a partner of the German Center for Diabetes Research (DZD e.V.). www.ddz.de/en 

The German Center for Diabetes Research (DZD) is a national association that brings together experts in the field of diabetes research and combines basic research, translational research, epidemiology and clinical applications. The aim is to develop novel strategies for personalized prevention and treatment of diabetes. Members are Helmholtz Munich – German Research Center for Environmental Health, the German Diabetes Center in Düsseldorf, the German Institute of Human Nutrition in Potsdam-Rehbrücke, the Paul Langerhans Institute Dresden of Helmholtz Munich at the University Medical Center Carl Gustav Carus of the TU Dresden and the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the Eberhard-Karls-University of Tuebingen together with associated partners at the Universities in Heidelberg, Cologne, Leipzig, Lübeck and Munich. www.dzd-ev.de/en