1900-LB: Efficacy and Safety of Artificial Pancreas in Patients with Type 1 Diabetes—A Systematic Review and Meta-analysis

Introduction & Objective: Artificial pancreas (AP) studies are upsurging, half of which were published in the last 5 years. We aimed to evaluate the efficacy and safety of AP in patients with type 1 diabetes (T1D).

Methods: We searched PubMed, Embase, Cochrane Library, web of science and ClinicalTrials.gov from inception to August 31, 2023. Randomized clinical trials that compared artificial pancreas with other insulin-based treatments in patients with T1D were considered eligible. The primary outcome was percentage of time in range (TIR) (3.9-10.0 mmol/L). Secondary outcomes were other glycemic metrics derived from continuous glucose monitoring, HbA1c and insulin dose. Safety outcomes included the incidence of severe hypoglycemia and diabetic ketoacidosis.

Results: A total of 3623 patients with 73 comparisons from 65 trials were included. The percentage of TIR was 11.74% (95% CI 9.37 to 14.12, P < 0.001) higher with AP compared with control treatments. Patients on AP had more pronounced improvement of time below range when diabetes duration was more than 20 years (-1.80% vs. -0.86%, P = 0.031) and baseline HbA1c lower than 7.5% (-1.93% vs. -0.87%, P = 0.033). Full closed-loop systems revealed a greater improvement in time above range compared with hybrid closed-loop systems (-15.53% vs. -9.22%, P = 0.020). Notably, glycemia risk index (GRI) (-3.74 [CI, -6.34 to -1.14], P < 0.01) was also improved with AP therapy.

Conclusion: AP showed significant advantages compared to other insulin-based treatments in improving glucose control represented by TIR and GRI in patients with T1D, with more favorable effect in hyperglycemia by full closed-loop systems as well as less hypoglycemia for patients who are within target for glycemic control and have longer diabetes duration.