Efficacy and Management of Automated Insulin Delivery Systems Perioperatively in Type 1 Diabetes: A Scoping Review.

Individuals with type 1 diabetes require careful perioperative management to minimize risks and optimize outcomes. Automated insulin delivery (AID) systems have demonstrated efficacy in improving glycemic management in outpatient settings. However, the safety and effectiveness of their use during surgery remains unclear. We aimed to synthesize the existing literature evaluating the perioperative use of AID systems in individuals with type 1 diabetes undergoing surgical procedures. A comprehensive search of PubMed, Ovid/MEDLINE, and CINAHL was conducted through May 20, 2025. Eligible studies included adults or children with type 1 diabetes undergoing surgery using AID systems with reported glycemic outcomes. Data were extracted from cohort studies, case reports, and expert guidance documents. Screening and data extraction were performed in Covidence by 3 independent reviewers. Sixteen studies were included: 2 observational cohorts, 9 case reports/series, 2 reviews, 1 retrospective study, 1 randomized controlled trial, and 1 expert guidance document. Across all studies, continuation of AID systems perioperatively was associated with long-duration time in range, minimal hypoglycemia, and no severe adverse events such as diabetic ketoacidosis. Technical concerns included continuous glucose monitoring signal interference from medications or surgical equipment. Expert guidance emphasized individualized planning, intraoperative monitoring, and device-specific considerations. Preliminary evidence suggests that perioperative continuation of AID systems is safe and feasible in select individuals with type 1 diabetes. However, despite promising glycemic outcomes, the current literature is limited to small-scale, mostly observational data. Larger prospective studies are needed to validate safety, inform standardized protocols, and support widespread clinical adoption.