Automated Insulin Delivery for Minoritized and Nonminoritized Populations With Type 1 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE

Despite the efficacy of diabetes technologies, significant ethnic and racial disparities persist in the care and outcomes of individuals with type 1 diabetes. Therefore, this study evaluates the efficacy and safety of automated insulin delivery (AID) systems in nonminoritized (non-Hispanic White) and minoritized (Hispanic, non-Hispanic Black, Asian, and others) populations with type 1 diabetes.

METHODS

We conducted a systematic review and meta-analysis of studies identified on PubMed, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov up to August 18, 2025. The primary outcome was the percentage of time-in-range (3.9-10.0 mmol/L). Secondary outcomes included time-below-range and glycated hemoglobin. Data were pooled as mean differences (MDs) with 95% CIs.

RESULTS

Twelve studies involving 327 participants from minoritized groups and 1377 participants from nonminoritized groups were included. AID systems significantly improved time-in-range in both minoritized (MD 13.90% [95% CI 9.64 to 18.16], I2 = 20%, P < .0001; high certainty) and nonminoritized groups (MD 10.66% [95% CI 9.12 to 12.21], I2 = 15%, P < .0001; high certainty). Favorable effects were observed on glycated hemoglobin for both minoritized (MD -0.49% [95% CI -0.69 to -0.29]) and nonminoritized groups (MD -0.34% [95% CI -0.46 to -0.23]). No significant increase in severe hypoglycemia or diabetic ketoacidosis was observed.

CONCLUSION

The AID systems improve glycemic outcomes in minoritized and nonminoritized populations with type 1 diabetes and have good safety profiles. AID systems hold promise for reducing racial and ethnic disparities in diabetes care and outcomes.