Automated Insulin Delivery for Patients with Type 2 Diabetes: A Narrative Review

Despite the availability of newer antidiabetic medications, many patients with type 2 diabetes mellitus still do not achieve their glycemic targets and require insulin treatment. Research from a limited number of randomized controlled trials and observational studies suggests that Automated Insulin Delivery (AID) systems are safe and effective for treating individuals with type 2 diabetes. With the implementation of a hybrid insulin pump, an average reduction in HbA1c of 0.6 to 0.9 percentage points is achieved, along with an increase in Time in Glucose Range (70-180 mg/dL) (3.9-10.0 mmol/L) of 7 to 21 percentage points. This improvement corresponds to an additional 1.7 to 5.1 hours of euglycemia per day, without increasing the risk of hypoglycemia or diabetic ketoacidosis, and with a slight increase in body weight, potentially reflecting improved glycemic control. Concomitant treatment with GLP-1RA and/or SGLT-2 inhibitors has minimal effect on the magnitude of glycemic improvement achieved after switching to AID therapy, although evidence remains limited. Both the effectiveness and device-related adverse reactions are similar to those observed in patients with type 1 diabetes. Although individuals with type 2 diabetes who require insulin treatment are generally older and may be less familiar with technology, training in the necessary skills and adherence to AID use in real-world settings appear feasible. Treatment with AID may slightly improve quality of life and reduce diabetes-related stress.