Jul 2026· Annals of Medicine and Surgery· Vol 88, pp. 5175 - 5182· 0 citations· 52 references
Medicine
TL;DR
Close-loop insulin delivery systems seem to be a more clinically successful option for controlling diabetes mellitus than SAP therapy, and sensor-augmented and closed-loop systems offer better glucose control and lower hypoglycemia rates compared to traditional therapies.
Abstract
Background and objective: The global rise in the incidence of diabetes mellitus necessitates innovative management strategies to mitigate the severity of the disease. The mainstay of diabetes treatment is still insulin therapy, although there are drawbacks, such as the need to maintain ideal glycemic control while lowering the risk of hypoglycemia and user fatigue. The development, clinical usefulness, and constraints of insulin delivery systems are examined in this narrative review, with particular attention to sensor-augmented and closed-loop technologies. Methods: A thorough electronic database search was conducted to obtain pertinent data on major insulin delivery devices, including sensor-augmented and closed-loop systems. We studied advancements in insulin delivery systems over time and their impact on the management of diabetes mellitus. We thoroughly examined both qualitative and quantitative data to summarize our conclusions. Key content and findings: Closed-loop insulin delivery systems, which combine insulin pumps, advanced control algorithms, and continuous glucose monitoring, are the next step forward in the treatment of diabetes. These systems autonomously regulate blood glucose levels, reducing the need for user intervention. Closed-loop devices outperform sensor-augmented pump (SAP) treatment in reducing hypoglycemia, extending the time-in-range, and lowering self-management responsibilities. In order to provide real-time control, closed-loop systems dynamically modify insulin delivery in response to glucose variations by using algorithms powered by artificial intelligence. Because SAP therapy depends more on user input and may not be as successful in providing consistent glycemic control, this capability helps overcome its drawbacks. Further improving overall safety and efficacy, the closed-loop technique decreases blood glucose variability. Conclusion: The two primary developments in diabetes care are sensor-augmented and closed-loop insulin devices, which offer better glucose control and lower hypoglycemia rates compared to traditional therapies. Closed-loop insulin delivery systems seem to be a more clinically successful option for controlling diabetes mellitus than SAP therapy.
Randomized and real-world studies demonstrate that AID systems significantly improve A1C and time in range while minimizing hypoglycemia, without increasing treatment complexity or patient burden, and position AID as a practical and effective strategy to overcome long-standing therapeutic inertia in type 2 diabetes.
Z. Tariq, Grazia Aleppo, Anders L Carlson et al.· Endocrine Practice· 0 citations
A practice-oriented evaluation of the indications, clinical benefits, and safety of modern diabetes technologies and suggests that technologies should be offered according to individual needs, abilities, preferences, and life circumstances and implemented early, including at the time of diagnosis.
A. Mathew, Dagmar Führer· Innere Medizin· 0 citations
This in-depth analysis explores the clinical performance and safety profiles of multiple cutting-edge diabetes management tools and treatment approaches in type 1 diabetes patients. The initial research assesses the advanced hybrid closed-loop (AHCL) system (Medtronic MiniMed 780G) among pediatric and adolescent populations, showing notable enhancements in blood sugar regulation within 14 days— especially at night. It increases the duration within the target glucose range (70-140 mg/dL), lowers average glucose levels, and does not raise the risk of hypoglycemia. The second investigation contrasts fast-acting insulin aspart (FA) and insulin aspart (IAsp) when used in the Medtronic 670G hybrid closed-loop (HCL) system. It finds that FA notably decreases 1-hour post-meal blood glucose, extends the time within the target range (70-180 mg/dL), and has no severe hypoglycemic incidents. The third research evaluates the combination of real-time continuous glucose monitoring (RT-CGM) and insulin pump treatment against multiple daily injections (MDI) in adult type 1 diabetes patients new to insulin pumps. It shows a marked drop in A1c levels in the experimental group compared to the control group. Taken together, these studies emphasize the potential advantages of advanced diabetes technologies and treatments in enhancing blood sugar control and patient results in type 1 diabetes care. Future research should focus on long-term effects, larger sample sizes, and comprehensive evaluations of patient satisfaction and quality of life in constructing both multiple daily injections (MDI) and hybrid closed-loop (AHCL) system.
ackground: Type 2 diabetes mellitus (T2DM) is fundamentally characterised by a progressive, inexorable
decline in pancreatic beta-cell function superimposed on peripheral insulin resistance. Although initial
management relies on lifestyle modifications and non-insulin antihyperglycemic therapies, a substantial
proportion of patients eventually require exogenous insulin to achieve and maintain optimal glycemic
targets.
Aims: This review synthesises current clinical evidence, international consensus guidelines, and recent
therapeutic breakthroughs to provide an operational framework on the clinical triggers ("when"),
physiological rationales ("why"), and practical algorithms ("how") of initiating insulin therapy.
Methods: A comprehensive literature search of electronic databases, including PubMed, MEDLINE, and
Embase, was conducted to identify English-language, peer-reviewed literature, clinical guidelines, and
landmark trials concerning insulin therapy in T2DM. This review evaluates data from foundational clinical
trials (UKPDS, ACCORD, ADVANCE, and the GRADE study) alongside current consensus
recommendations from the American Diabetes Association (ADA) and the European Association for the
Study of Diabetes (EASD). Literature tracking clinical thresholds for initiation, comparative data on
traditional insulin regimens (basal, biphasic, basal-bolus), and Phase 3 clinical trial data for once-weekly
basal insulins and digital health technologies published between 2019 and 2026 were extracted and
evaluated.
Conclusions: Overcoming clinical inertia requires proactive clinician intervention, structured patient
education to address psychological insulin resistance, and the early adoption of advanced monitoring
technologies. Timely and tailored implementation of insulin therapy remains a cornerstone in altering the
long-term microvascular and macrovascular trajectory of patients with T2DM.
Keywords: Type 2 Diabetes Mellitus; Insulin Initiation; Basal Insulin; Clinical Inertia; Hypoglycemia.
Manal Mekki· Journal of Medical Science A...· 0 citations
Introduction: Diabetes mellitus remains a major public health challenge worldwide, requiring continuous monitoring, long-term treatment, and active patient participation. Recent advances in telemedicine, continuous glucose monitoring systems, mobile health applications, and artificial intelligence have created new opportunities for remote and personalized diabetes management.
Aim: This narrative review evaluated the impact of telemedicine and digital health technologies on metabolic control, treatment adherence, self-management behaviors, and psychosocial outcomes among adults with type 1 and type 2 diabetes mellitus.
Materials and Methods: A narrative review of the literature was conducted using keywords in the PubMed database. Recent studies involving adult patients with type 1 and type 2 diabetes were analyzed. Attention was paid to outcomes related to glycated hemoglobin (HbA1c), continuous glucose monitoring metrics, treatment adherence, patient engagement, self-management, and quality-of-life indicators.
Results: Most reviewed studies demonstrated that telemedicine interventions significantly improved glycemic control, particularly by reducing HbA1c levels. Digital care models incorporating continuous glucose monitoring increased Time in Range and reduced hyperglycemic exposure. Telemedicine was also associated with improved adherence to treatment recommendations, greater patient engagement, enhanced self-management competencies, and positive psychosocial outcomes, including improved quality of life and reduced diabetes-related distress. The greatest benefits were observed in patients with poor baseline metabolic control and in programs integrating remote monitoring with structured educational support.
Conclusions: Telemedicine represents an effective and innovative complement to conventional diabetes care. Digital health technologies facilitate personalized disease management, improve patient participation in therapeutic processes, and may contribute to more accessible and sustainable healthcare delivery.
A. Wojtera, Nina Urantówka, A. Węglarz et al.· International Journal of Inn...· 0 citations
