Comparative Efficacy of Insulin Delivery Modalities on Glycaemic Control in Adults With Type 2 Diabetes: A Systematic Review and Network Meta-Analysis.
Ruining Yang, Xiyi Lu, Yixian Liang et al.
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In 30 seconds
This systematic review and network meta-analysis compared insulin delivery modalities in adults with insulin-treated type 2 diabetes, using parallel-group randomised trials identified through searches of eight databases and two trial registries. Thirty-seven reports covering 36 trials and 4157 participants were included; median follow-up was 12 weeks. In the primary analysis, hybrid closed-loop delivery versus multiple daily injections reduced HbA1c by MD -0.79% (95% CI -1.33 to -0.25) and increased time in range by MD +16.00 percentage points (95% CI +8.77 to +23.22), while also increasing body weight.
Key findings
- Hybrid closed-loop versus multiple daily injections reduced HbA1c (MD -0.79%, 95% CI -1.33 to -0.25).
- Hybrid closed-loop increased time in range by MD +16.00 percentage points (95% CI +8.77 to +23.22) and reduced time above range by MD -13.48 percentage points (95% CI -23.05 to -3.91).
- Hybrid closed-loop increased body weight (MD +1.58 kg, 95% CI +0.75 to +2.40) and reduced insulin dose (MD -15.69 U/day, 95% CI -31.33 to -0.06).
- Continuous subcutaneous insulin infusion reduced HbA1c (MD -0.47%, 95% CI -0.74 to -0.20) and insulin dose.
Why it matters
The findings suggest that insulin delivery modality may influence glycaemic control as well as insulin requirements in adults with insulin-treated type 2 diabetes. The observed weight increase with hybrid closed-loop delivery and limited safety evidence are relevant when weighing potential benefits. Results for fully closed-loop delivery remain uncertain, as they derive from one short trial.
What to keep in mind
Median follow-up was 12 weeks; most trials had risk-of-bias concerns, and a low-risk sensitivity analysis was infeasible. Fully closed-loop estimates came from one short trial.