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This review evaluates the current landscape and future potential of AID systems without meal announcement, particularly focusing on real-world insights from open-source AID (OS-AID) technologies. Although commercial AID systems operating in hybrid closed-loop (HCL) mode have improved glycaemic outcomes, they remain dependent on manual meal announcement and user-driven actions, limiting their real-world utility. Current versions of OS-AID systems, developed by the diabetes community, can allow operation without meal announcements, presenting an opportunity to move closer to truly automated diabetes management. Recent clinical trials suggest that OS-AID systems can effectively manage glucose levels without meal announcements, achieving glucose levels comparable with those obtained by AID systems in HCL mode, with the potential of reduced management burden for users. However, practical challenges persist, including the need for expert configuration and handling of rapid changes in insulin sensitivity, such as during exercise or rapid glucose fluctuations following predicted low-glucose. This review synthesises insights from user and healthcare professional experiences, and emerging clinical evidence. It highlights the fact that successful implementation of AID without meal announcement requires advanced algorithmic responsiveness, user personalisation and ongoing clinician engagement. Looking forward, integrating adjunctive therapies, artificial intelligence and enhanced physiological modelling will likely enhance system performance to drive the next generation of diabetes care towards wider adoption and true \u2018set-and-forget\u2019 functionality.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Graphical Abstract<\/jats:bold>\n                  <\/jats:p>","DOI":"10.1007\/s00125-025-06644-8","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T21:33:02Z","timestamp":1768858382000},"page":"557-567","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Fully closed-loop systems: can people with type 1 diabetes just do it? Insights from open-source systems"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8055-944X","authenticated-orcid":false,"given":"Rayhan","family":"Lal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6590-245X","authenticated-orcid":false,"given":"Katarina","family":"Braune","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9176-6308","authenticated-orcid":false,"given":"Dana M.","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5535-3474","authenticated-orcid":false,"given":"Lenka","family":"Petruzelkova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0454-6679","authenticated-orcid":false,"given":"Martin","family":"de Bock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6611-8245","authenticated-orcid":false,"given":"Sufyan","family":"Hussain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"issue":"S7","key":"6644_CR1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1111\/dom.15920","volume":"26","author":"A Anandhakrishnan","year":"2024","unstructured":"Anandhakrishnan A, Hussain S (2024) Automating insulin delivery through pump and continuous glucose monitoring connectivity: maximizing opportunities to improve outcomes. 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We are also grateful to T. Street (\n                      \n                      ) for kindly allowing us to use resources adapted in this manuscript.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Acknowledgements"}},{"value":"RL is supported by NIDDK (K23 DK122017, P30DK116074), Breakthrough T1D and Helmsley Charitable Trust. KB is supported by the German Research Foundation (DFG, SFB 1340\/2), GBA Innovationsausschuss (01VSF24052) and ISPAD-Breakthrough T1D fellowship. SH is supported by the Medical Research Council Clinical Academic Partnership award (MR\/W030004\/1).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"All authors declare no financial support or compensation related to the preparation of this review. RL is a consultant for Abbott Diabetes Care, Biolinq, Capillary Biomedical, Deep Valley Labs, Gluroo, Portal Diabetes, Sanofi and Tidepool. He has served on advisory boards for ProventionBio and Lilly. He receives research support through his institution from Insulet, Medtronic, Tandem and Sinocare. KB has previously served on advisory boards and provided paid consultancy for Dexcom, Medtronic Diabetes, Roche Diabetes Care, Sanofi Diabetes, Abbott Diabetes Care, Diabeloop, Diabetes Center Berne and Tidepool. None of these entities were involved in the conception, data provision, analysis or funding of the present work. LP has received speaking fees from Medtronic, Abbott Diabetes Care and Dexcom. MDB has received research funding from Novo Nordisk, Ypsomed, Dexcom, Insulet, Medtronic and BetaBionics. MDB has received honoraria or speaking fees from Novo Nordisk, Sanofi, Pfizer, Medtronic, Boehringer Ingelheim, Ypsomed, Dexcom and Insulet. MDB has served on advisory boards for Tandem and Dexcom. SH has served on the advisory board for Tandem, Dexcom, Medtronic, Sanofi, Roche and Vertex, and has undertaken non-promotional educational and\/ or consultancy work for Abbott UK, Insulet, Dexcom, Sanofi, Lilly and Roche. SH\u2019s institution has received research grant support from Abbott and Insulet. The authors declare that there are no other relationships or activities that might bias, or be perceived to bias, their work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"All authors were responsible for drafting the article and reviewing it critically. All authors approved the version to be published.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}