Glycemic and psychosocial outcomes of automated insulin delivery in older and high-risk populations with type 1 diabetes: a systematic review and meta-analysis

Abstract Background Automated insulin delivery (AID) has revolutionized care for people with type 1 diabetes. However, its efficacy and safety in older adults (≥60 years) and high-risk populations, including those with impaired awareness of hypoglycemia, or cognitive or functional impairment, have not been systematically evaluated. Materials and methods CENTRAL, PubMed, Web of Science, Scopus, and ClinicalTrials.gov from inception to March 10, 2026. Studies on automated insulin delivery in older and high-risk individuals with type 1 diabetes were included. The primary outcome was time in range (3.9-10.0 mmol/L [70-180 mg/dL]). Secondary outcomes included time above range, time below range, psychosocial well-being (Gold, Clarke, and Hypoglycemia Fear Survey score), and serious adverse events. Pooled effect sizes were estimated with random-effects models (PROSPERO, CRD420251273526). Results Twenty-three studies involving 967 participants (11 randomized controlled trials, 3 single-arm, and 9 cohort studies) were included. Automated insulin delivery increased time in range by 11.38% (95% CI: 8.07-14.70; I2 = 70%; P Conclusion Automated insulin delivery exhibits favorable glycemic outcomes and safety profiles in older and high-risk individuals with type 1 diabetes, suggesting potential benefits for populations traditionally considered vulnerable, although no significant improvements were observed in psychosocial outcomes.