Advances in diabetes technology: clinical implications, limitations, and future perspectives.

Diabetes technology has transformed substantially over the past two decades, becoming central to modern diabetes management. Continuous glucose monitoring (CGM), automated insulin delivery (AID) systems, and smart insulin pens have reshaped both the assessment of glycemic control and diabetes treatment, particularly in people with type 1 diabetes (T1D) and selected individuals with insulin-treated type 2 diabetes (T2D). Among these technologies, CGM represents a major paradigm shift, providing continuous insight into glucose trends, variability, and time spent within clinically meaningful glycemic ranges, thereby complementing-and in many cases replacing-traditional self-monitoring of blood glucose. This narrative review summarizes evidence from randomized controlled trials and real-world studies regarding the evolution of CGM technology, insulin delivery strategies-including conventional insulin pumps, sensor-augmented pumps, and hybrid closed-loop systems-and the application of these technologies in specific clinical contexts, such as pregnancy, gestational diabetes, and perioperative and inpatient settings. While these systems offer clear metabolic and psychosocial benefits, important limitations remain, particularly those related to delayed insulin pharmacokinetics, sensor lag during rapid glucose changes, and user-dependent factors. Emerging developments, including fully closed-loop and dual-hormone systems as well as the growing role of artificial intelligence in CGM data analysis and risk prediction are also explored. Future development is expected to focus on improved personalization, tighter integration of technologies, and a transition toward more predictive and proactive diabetes care.