Effect of artificial pancreas systems on glycaemic control in patients with type 1 diabetes: a systematic review and meta-analysis of outpatient randomised controlled trials
Abstract
Background Closed-loop artificial pancreas systems have been in development for several years, including assessment in numerous varied outpatient clinical trials. We aimed to summarise the efficacy and safety of artificial pancreas systems in outpatient settings and explore the clinical and technical factors that can affect their performance.Methods We did a systematic review and meta-analysis of randomised controlled trials comparing artificial pancreas systems (insulin only or insulin plus glucagon) with conventional pump therapy (continuous subcutaneous insulin infusion [CSII] with blinded continuous glucose monitoring [CGM] or unblinded sensor-augmented pump [SAP] therapy) in adults and children with type 1 diabetes. We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies published from 1946, to Jan 1, 2017. We excluded studies not published in English, those involving pregnant women or participants who were in hospital, and those testing adjunct medications other than glucagon. The primary outcome was the mean difference in percentage of time blood glucose concentration remained in target range (3·9-10 mmol/L or 3·9-8 mmol/L, depending on the study), assessed by random-effects meta-analysis. This study is registered with PROSPERO, number 2015:CRD42015026854.Findings We identified 984 reports; after exclusions, 27 comparisons from 24 studies (23 crossover and one parallel design) including a total of 585 participants (219 in adult studies, 265 in paediatric studies, and 101 in combined studies) were eligible for analysis. Five comparisons assessed dual-hormone (insulin and glucagon), two comparisons assessed both dual-hormone and single-hormone (insulin only), and 20 comparisons assessed single-hormone artificial pancreas systems. Time in target was 12·59% higher with artificial pancreas systems (95% CI 9·02-16·16; p<0·0001), from a weighted mean of 58·21% for conventional pump therapy (I 2=84%). Dual-hormone artificial pancreas systems were associated with a greater improvement in time in target range compared with single-hormone systems (19·52% [95% CI 15·12-23·91] vs 11·06% [6·94 to 15·18]; p=0·006), although six of seven comparisons compared dual-hormone systems to CSII with blinded CGM, whereas 21 of 22 single-hormone comparisons had SAP as the comparator. Single-hormone studies had higher heterogeneity than dual-hormone studies (I 2 79% vs 66%). Bias assessment characteristics were incompletely reported in 12 of 24 studies, no studies masked participants to the intervention assignment, and masking of outcome assessment was not done in 12 studies and was unclear in 12 studies.Interpretation Artificial pancreas systems uniformly improved glucose control in outpatient settings, despite heterogeneous clinical and technical factors.Funding None.
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CGM and closed-loop insulin delivery systems have been shown to significantly improve TIR, reduce HbA1c levels, and decrease TBR/TAR, thereby enhancing glycemic stability in both Type 1 and T2D patients.
“Regarding glycemic control, CGM and closed‐loop insulin delivery systems (AID, CLS, and artificial pancreas) have been shown to significantly improve TIR, reduce HbA1c levels, and decrease TBR/time above range (TAR), thereby enhancing glycemic stability in both Type 1 and T2D patients [24, 25, 35, 36].”
From Effectiveness of Wearable Devices for Diabetes Management: An Overview of Systematic Reviews and Meta‐Analyses (2026) · cites this paper as [35]
Artificial pancreas systems further enhance TIR.
“and artificial pancreas systems further enhance TIR [35].”
From Effectiveness of Wearable Devices for Diabetes Management: An Overview of Systematic Reviews and Meta‐Analyses (2026) · cites this paper as [35]
Automated insulin delivery systems have greater benefits than insulin pumps and CGM alone.
“Automated insulin delivery systems (AID), which integrate insulin pumps and CGM, have even greater benefits.”
Previous studies demonstrate glycaemic benefits for CGM and insulin pump.
“HbA1c was lower among CGM and insulin pump users in the BETTER Registry, which is consistent with previous studies demonstrating glycaemic benefits for these technologies.”
Automated insulin delivery (AID) or hybrid closed-loop system (HCL) is associated with a reduced risk of hypoglycemia and a higher TIR.
“This technology is associated with a reduced risk of hypoglycemia and a higher TIR [ 63 ].”
From Hypoglycemia Unawareness—A Review on Pathophysiology and Clinical Implications (2024) · cites this paper as [63]
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Self-citationTalaiti, M., Liao, X., Abulimiti, N., Zeng, M., & Wang, Y. (2026) · Journal of Diabetes Research · doi:10.1155/jdr/1464982
- Authors
- Weisman, A., Bai, J.-W., Cardinez, M., Kramer, C. K., & Perkins, B. A.
- Affiliations
- Mount Sinai Hospital (CA)
- Corresponding author
- Weisman, Alanna
- Venue
- The Lancet Diabetes & Endocrinology
- Publisher
- Elsevier BV
- Published
- 2017-07
- Volume
- 5
- Issue
- 7
- Pages
- 501-512
- ISSN
- 2213-8587 (ISSN-L)
- OpenAlex
- W2615150331
- Cited by
- 463
- References
- 61
- Citations by year
- 2026: 28 · 2025: 42 · 2024: 44 · 2023: 40 · 2022: 54 · 2021: 66 · 2020: 66 · 2019: 56 · 2018: 54 · 2017: 11
- FWCI
- 7.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Diabetes & Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- artificial pancreas, type 1 diabetes, glycemic control, time in range, insulin pump therapy, sensor-augmented pump, continuous glucose monitoring, pediatric patients, adults, HbA1c, hypoglycemia
- MeSH terms
- Diabetes Mellitus, Type 1, Humans, Hyperglycemia, Hypoglycemia, Randomized Controlled Trials as Topic, Pancreas, Artificial
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