Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyMay 2025
Glycaemic outcomes were significantly better across a range of groups.
Automated insulin delivery systems are insulin pumps that use continuous glucose monitoring (CGM) data to adjust insulin delivery automatically. These devices are available already for patients with type 1 diabetes, but their use in patients with type 2 diabetes has not been evaluated broadly.
In this industry-sponsored North American trial, researchers randomised 319 adults with type 2 diabetes who used insulin (multiple daily injections or traditional insulin pump) either to use an automated delivery system or to continue their usual method of insulin use; all patients received CGM. Patients who took other guideline-recommended medications were well represented.
After 13 weeks, glycated haemoglobin (HbA1c) decreased significantly more in the automated-delivery group (mean changes, 0.9 vs 0.3 percentage points). Patients in the automated-delivery group spent an average of 3.4 additional hours daily in the target-glucose range. Hypoglycaemia was uncommon in both groups. Virtually all evaluated subgroups had better outcomes with automated delivery, and its benefit was even more pronounced among patients with higher HbA1c at baseline.
Comment: Although this trial did not include clinical outcomes, improvements in glycaemic control seen with automated delivery were impressive in patients with an array of baseline characteristics. These systems are expensive and in the USA are not yet covered by insurance for type 2 diabetes. But just as CGMs have exploded in popularity, these automated devices eventually might become common in primary care settings.
Sarah E. Post, MD, Lecturer in Medicine, Harvard Medical School; Internal Medicine Physician, Atrius Health, Boston, USA.
Kudva YC, et al. A randomized trial of automated insulin delivery in type 2 diabetes. N Engl J Med 2025 Mar 19; e-pub (https://doi.org/10.1056/NEJMoa2415948).
This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine.