Automated Insulin Delivery Systems in Cystic Fibrosis-Related Diabetes: A Systematic Review and Meta-Analysis.

OBJECTIVES

To assess the effects of automated insulin delivery systems (AIDs) on glycemic control and selected metabolic and pulmonary outcomes in people with cystic fibrosis related diabetes (pwCFRD).

METHODS

We searched MEDLINE (via PubMed), Embase, and Cochrane Library for studies of AIDs in pwCFRD. Eligible studies included at least 14 days of follow-up and reported continuous glucose monitoring outcomes. The primary outcome was time in range (3.9-10.0 mmol/L or 70-180 mg/dL). Additional outcomes included time above range (>10.0 mmol/L or 180 mg/dL), time below range (<3.9 mmol/L or 70 mg/dL), average glucose, body mass index, and FEV1. We performed single-arm meta-analyses using a random-effects model.

RESULTS

Four studies (n = 69) met inclusion criteria. AIDs increased time in range by 9.55% (95% CI 1.49, 17.61; P = .02) at short-term (14-30 days) and 11.55% (95% CI 5.61, 17.50; P < .001) at long-term (≥12 weeks) follow-up, respectively. Time above range decreased by 8.41% (95% CI -15.59, -1.22; P = .022) and 12.96% (95% CI -17.67, -8.26; P < .001) at short- and long-term, respectively. Average glucose decreased by 1.01 mmol/L (18 mg/dL) (95% CI -1.98, -0.04; P = .042) and 1.12 mmol/L (20 mg/dL) (95% CI -1.70, -0.54; P < .001) at short- and long-term, respectively. AIDs did not change time below range, body mass index, and FEV1.

CONCLUSIONS

AIDs improved glycemic control in pwCFRD without increasing hypoglycemia, with short-term benefits persisting over 12 weeks. Larger randomized trials are needed to confirm these findings.