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Use of insulin pumps and closed‐loop systems among people living with diabetes: A narrative review of clinical and cost‐effectiveness to enable access to technology and meet the needs of payers

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Jendle, Johan, Reznik, Yves·2023·Diabetes, Obesity and Metabolism
DOI 10.1111/dom.15087
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Abstract

The use of continuous subcutaneous insulin infusion (CSII) via insulin pumps is today considered standard of care for type 1 diabetes (T1D). Closed‐loop systems combining continuous glucose monitoring with automated algorithm‐driven insulin delivery have been shown to be safe and efficacious in randomized controlled trials and real‐life studies in both paediatric and adult participants with T1D. Implementation of hybrid closed‐loop (HCL) systems has shown incremental effectiveness, with further reduction of hypoglycaemia and hyperglycaemia. Although less extensively studied in type 2 diabetes (T2D), insulin pumps have demonstrated their effectiveness in glucose control, along with a reduction in need for insulin and a neutral effect on weight. Recent studies have also shown promising results with the use of HCL systems in T2D. Cost‐effectiveness studies in both T1D and T2D have shown that pump use is cost‐effective in several countries, leading to improvements in quality‐adjusted life‐years. Insulin pumps are currently reimbursed for T1D in many European countries, but in only a few for individuals with T2D. HCL systems are to be evaluated in future trials performed in T2D to compare their incremental efficacy and cost‐effectiveness in comparison with available intensification tools which include multiple daily insulin injections, metformin, sodium‐glucose cotransporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists. There is a need for updated guidelines for the use of CSII and HCL in individuals living with T2D based on the emerging evidence, with identification of and recommendations for the people who would benefit the most, which would eventually form a basis for reimbursement and health policies.

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  • Available data suggest that hybrid closed‐loop systems (Automated Insulin Delivery, AID) can increase TIR and reduce hypoglycemia in patients with DGP, with improvements comparable to those observed in individuals without gastrointestinal complications, although data remain limited and largely observational.

    “Avaiable data suggest that such systems can increase TIR and reduce hypoglycemia in patients with DGP, with improvements comparable to those observed in individuals without gastrointestinal complications, although data remain limited and largely observational [153–157].”

    From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [155]

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Cited by

Sorted by citations

Authors
Jendle, J., & Reznik, Y.
Affiliations
  • Örebro University (SE)
  • Centre Hospitalier Universitaire de Caen Normandie (FR)
Corresponding author
Jendle, Johan
ORCID
Venue
Diabetes, Obesity and Metabolism
Publisher
Wiley
Published
2023-04-26
Volume
25
Issue
S2
Pages
21-32
ISSN
  • 1462-8902 (ISSN-L)
  • 1463-1326
DOI
10.1111/dom.15087
OpenAlex
W4365443911
Cited by
26
References
5
Citations by year
2026: 4 · 2025: 13 · 2024: 6 · 2023: 3
FWCI
0.94
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Obesity and Metabolism (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
insulin pump, insulin pump therapy, closed-loop systems, hybrid closed-loop system, type 1 diabetes, type 2 diabetes, continuous glucose monitoring, artificial pancreas, cost-effectiveness, reimbursement, hypoglycemia, glycemic control, health policy
MeSH terms
Sodium-Glucose Transporter 2 Inhibitors, Adult, Blood Glucose, Child, Cost-Benefit Analysis, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Technology, Blood Glucose Self-Monitoring, Insulin, Regular, Human

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