The Effect of Automated Insulin Delivery Systems on Sleep Quality and Quantity in Type 1 Diabetes: A Systematic...

Automated insulin delivery (AID) systems have improved treatment for people with type 1 diabetes (T1D). Treatment with AID may also improve sleep. However, there is a need to examine this further.

To systematically collect and synthesize data from available studies that have assessed subjective and objective sleep parameters in people with T1D transitioning to AID systems.

Searches were performed in multiple databases, and the systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses were performed for randomized clinical trials (RCTs) and prospective studies when feasible; incompatible studies were reviewed narratively. Data from adults, children, and caregivers of children were analyzed separately.

A total of 27 studies met eligibility criteria. Sufficient data for meta-analysis were available only for subjective sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). Among adult AID users, no significant change in PSQI scores was observed in RCTs, while prospective studies found a minor improvement with AID systems (study n = 7, mean -0.42 points, 95% confidence interval [CI]: -0.81, -0.04, p = 0.03). For caregivers of children with T1D, analyses of both RCTs and prospective studies found improved sleep quality with AID systems (RCTs: n = 2, mean -1.79 points, 95%CI: -2.96, -0.61, p = 0.003 | Prospective studies: n = 4, mean -1.24 points, 95%CI: -2.02, -0.46, p = 0.002). Data on children with T1D were not sufficiently available for meta-analysis. Studies varied considerably in terms of comparator treatments and populations of interest. Most studies were based on secondary or ad hoc analyses.

AID systems may improve perceived sleep quality in caregivers of children with T1D. The effect on adults with T1D is inconclusive, although prospective studies suggest a benefit. Studies reporting objective sleep measures and data regarding children with T1D are limited. Further research in these areas is needed.