Automated Insulin Delivery Systems in Hospitals: A Systematic Review with Meta-Analysis

Abstract

Inpatient diabetes management is challenging due to acute illness, variable insulin requirements, and reliance on intermittent point-of-care glucose testing. Both hyperglycemia and hypoglycemia are associated with increased costs, length of stay, morbidity, and mortality. However, efforts to achieve tighter glycemic targets are often limited by the risk of iatrogenic hypoglycemia. Notably, hypoglycemia (glucose <3.9 mmol/L, <70 mg/dL) occurs in approximately 10% of patients in intensive care unit (ICU) settings and 3.5% of non-ICU patients and is strongly linked to mortality. Automated insulin delivery (AID) systems may improve inpatient glycemic targets while minimizing the risk of hypoglycemia. This systematic review aimed to evaluate the effects of AID systems in hospital settings. A systematic literature search was conducted on March 27, 2026, in MEDLINE, Embase, and CENTRAL, without restrictions on publication date. Randomized controlled trials (RCTs) involving inpatients managed with AID systems were included if they reported glycemic and/or clinical outcomes. Analyses were performed for ICU and non-ICU settings separately. The primary outcome was time in range (TIR) 5.6–10.0 mmol/L (100–180 mg/dL). The reporting follows the PRISMA 2020 guidelines, and the protocol was registered with PROSPERO (CRD420261308501). A total of 4858 references were screened. Five RCTs from the non-ICU setting (N = 300 participants [>80% with type 2 diabetes]) and three RCTs from the ICU setting (N = 142 [with and without preexisting diabetes]) were identified. Meta-analysis of RCTs in the non-ICU setting showed that AID increased TIR by 24.6 percentage points (95% confidence interval 20.7–28.5). A meta-analysis on ICU data could not be conducted. Across all settings, AID was associated with reduced hyperglycemia without an increase in hypoglycemia. Clinical outcomes were sparsely reported. AID systems can be safely and effectively used in non-ICU hospital settings to improve glycemic outcomes. Larger, multicenter trials are needed to confirm clinical benefits and address implementation challenges.