{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:55:44Z","timestamp":1790729744192,"version":"4.1.0"},"reference-count":46,"publisher":"The Endocrine Society","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Automated insulin delivery (AID) has revolutionized care for people with type 1 diabetes. However, its efficacy and safety in older adults (\u226560 years) and high-risk populations, including those with impaired awareness of hypoglycemia, or cognitive or functional impairment, have not been systematically evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>CENTRAL, PubMed, Web of Science, Scopus, and ClinicalTrials.gov from inception to March 10, 2026. Studies on automated insulin delivery in older and high-risk individuals with type 1 diabetes were included. The primary outcome was time in range (3.9-10.0\u2005mmol\/L [70-180\u2005mg\/dL]). Secondary outcomes included time above range, time below range, psychosocial well-being (Gold, Clarke, and Hypoglycemia Fear Survey score), and serious adverse events. Pooled effect sizes were estimated with random-effects models (PROSPERO, CRD420251273526).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-three studies involving 967 participants (11 randomized controlled trials, 3 single-arm, and 9 cohort studies) were included. Automated insulin delivery increased time in range by 11.38% (95% CI: 8.07-14.70; I2 = 70%; P &amp;lt; .0001; very low certainty; equivalent to 2.7\u2005hours\/day). Time in range improvement was observed during the day (8.70%; 95% CI 5.18-12.22%) and overnight (13.35%; 95% CI 11.07-15.62%). Favorable improvement was also comparable among commercial and noncommercial systems. Automated insulin delivery reduced the time spent in hyperglycemia (\u22127.89%) and hypoglycemia (\u22121.16%). No significant differences in psychosocial well-being were observed. Diabetic ketoacidosis and severe hypoglycemia events were not significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Automated insulin delivery exhibits favorable glycemic outcomes and safety profiles in older and high-risk individuals with type 1 diabetes, suggesting potential benefits for populations traditionally considered vulnerable, although no significant improvements were observed in psychosocial outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgag344","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:40:37Z","timestamp":1788522037000},"source":"Crossref","is-referenced-by-count":0,"title":["Glycemic and psychosocial outcomes of automated insulin delivery in older and high-risk populations with type 1 diabetes: a systematic review and meta-analysis"],"prefix":"10.1210","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9704-3471","authenticated-orcid":false,"given":"Puguh","family":"Oktavian","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Universitas Airlangga , Surabaya 60132 ,","place":["Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5180-957X","authenticated-orcid":false,"given":"Citrawati Dyah","family":"Kencono Wungu","sequence":"additional","affiliation":[{"name":"Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga , Surabaya 60132 ,","place":["Indonesia"]},{"name":"Institute of Tropical Disease, Universitas Airlangga , Surabaya 60115 ,","place":["Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6964-9017","authenticated-orcid":false,"given":"Indah Mohd","family":"Amin","sequence":"additional","affiliation":[{"name":"Centre of PreClinical Science, Faculty of Dentistry, Universiti Teknologi MARA (UiTM) , Sungai Buloh, Selangor 47000 ,","place":["Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2339-5266","authenticated-orcid":false,"given":"Sony Wibisono","family":"Mudjanarko","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Faculty of Medicine, Universitas Airlangga , Surabaya 60132 ,","place":["Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"2026092920020569800_dgag344-B1","doi-asserted-by":"crossref","first-page":"e078432","DOI":"10.1136\/bmj-2023-078432","article-title":"Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study","volume":"385","author":"Yang","year":"2024","journal-title":"BMJ"},{"issue":"10","key":"2026092920020569800_dgag344-B2","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1111\/dme.12496","article-title":"Hypoglycaemia symptoms and impaired awareness of hypoglycaemia in adults with type 1 diabetes: the association with diabetes duration","volume":"31","author":"Olsen","year":"2014","journal-title":"Diabet Med"},{"issue":"12","key":"2026092920020569800_dgag344-B3","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1089\/dia.2016.0268","article-title":"Hypoglycemia in older adults with type 1 diabetes","volume":"18","author":"DuBose","year":"2016","journal-title":"Diabetes Technol Ther"},{"issue":"8","key":"2026092920020569800_dgag344-B4","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.2337\/dci19-0028","article-title":"Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range","volume":"42","author":"Battelino","year":"2019","journal-title":"Diabetes Care"},{"issue":"23","key":"2026092920020569800_dgag344-B5","doi-asserted-by":"crossref","first-page":"2397","DOI":"10.1001\/jama.2020.6928","article-title":"Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical trial","volume":"323","author":"Pratley","year":"2020","journal-title":"JAMA"},{"issue":"3","key":"2026092920020569800_dgag344-B6","doi-asserted-by":"crossref","first-page":"bvag007","DOI":"10.1210\/jendso\/bvag007","article-title":"Missed opportunities for risk reduction: type 1 diabetes management in older adults in DPV and T1DX-QI registries","volume":"10","author":"Fantasia","year":"2026","journal-title":"J Endocr Soc"},{"issue":"13","key":"2026092920020569800_dgag344-B7","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1056\/NEJMoa2205225","article-title":"Multicenter, randomized trial of a bionic pancreas in type 1 diabetes","volume":"387","author":"Bionic Pancreas Research Group","year":"2022","journal-title":"N Engl J Med"},{"issue":"18","key":"2026092920020569800_dgag344-B8","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1056\/NEJMoa1907863","article-title":"Six-month randomized, multicenter trial of closed-loop control in type 1 diabetes","volume":"381","author":"Brown","year":"2019","journal-title":"N Engl J Med"},{"key":"2026092920020569800_dgag344-B9","doi-asserted-by":"crossref","unstructured":"Oktavian P . Supplementary Material for glycemic and psychosocial outcomes of automated insulin delivery in older and high-risk populations with type 1 diabetes: a systematic review and meta-analysis. OSF. Published online August 7, 2026. Doi:10.17605\/OSF.IO\/93GPS","DOI":"10.1016\/j.eprac.2025.09.198"},{"key":"2026092920020569800_dgag344-B10","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"Rob 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"2026092920020569800_dgag344-B11","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"issue":"7650","key":"2026092920020569800_dgag344-B12","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"2026092920020569800_dgag344-B13","author":"Higgins"},{"issue":"8","key":"2026092920020569800_dgag344-B14","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.2337\/dc19-1785","article-title":"Time in range for multiple technologies in type 1 diabetes: a systematic review and network meta-analysis","volume":"43","author":"Pease","year":"2020","journal-title":"Diabetes Care"},{"issue":"12","key":"2026092920020569800_dgag344-B15","doi-asserted-by":"crossref","first-page":"2300","DOI":"10.2337\/dc23-0504","article-title":"Automated insulin delivery systems in children and adolescents with type 1 diabetes: a systematic review and meta-analysis of outpatient randomized controlled trials","volume":"46","author":"Zeng","year":"2023","journal-title":"Diabetes Care"},{"issue":"8","key":"2026092920020569800_dgag344-B16","doi-asserted-by":"crossref","first-page":"e2043","DOI":"10.1210\/clinem\/dgag133","article-title":"Automated insulin delivery in young children with type 1 diabetes: a systematic review and meta-analysis","volume":"111","author":"Oktavian","year":"2026","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2026092920020569800_dgag344-B17","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1177\/0962280216669183","article-title":"Optimally estimating the sample mean from the sample size, median, mid-range, and\/or mid-quartile range","volume":"27","author":"Luo","year":"2018","journal-title":"Stat Methods Med Res"},{"issue":"1","key":"2026092920020569800_dgag344-B18","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan","year":"2014","journal-title":"BMC Med Res Methodol"},{"issue":"4","key":"2026092920020569800_dgag344-B19","doi-asserted-by":"crossref","first-page":"517","DOI":"10.2337\/diacare.18.4.517","article-title":"Reduced awareness of hypoglycemia in adults with IDDM. A prospective study of hypoglycemic frequency and associated symptoms","volume":"18","author":"Clarke","year":"1995","journal-title":"Diabetes Care"},{"issue":"2","key":"2026092920020569800_dgag344-B20","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1111\/pedi.12951","article-title":"Assessing awareness of hypoglycemia in children and adolescents with type 1 diabetes: evaluation of established questionnaires","volume":"21","author":"Hatle","year":"2020","journal-title":"Pediatr Diabetes"},{"issue":"2","key":"2026092920020569800_dgag344-B21","doi-asserted-by":"crossref","first-page":"381","DOI":"10.2337\/dc21-1667","article-title":"Closed-loop insulin delivery versus sensor-augmented pump therapy in older adults with type 1 diabetes (ORACL): a randomized, crossover trial","volume":"45","author":"McAuley","year":"2022","journal-title":"Diabetes Care"},{"issue":"3","key":"2026092920020569800_dgag344-B22","doi-asserted-by":"crossref","first-page":"e135","DOI":"10.1016\/S2666-7568(22)00005-8","article-title":"Hybrid closed-loop glucose control compared with sensor augmented pump therapy in older adults with type 1 diabetes: an open-label multicentre, multinational, randomised, crossover study","volume":"3","author":"Boughton","year":"2022","journal-title":"Lancet Healthy Longev"},{"issue":"1","key":"2026092920020569800_dgag344-B23","doi-asserted-by":"crossref","first-page":"EVIDoa2400200","DOI":"10.1056\/EVIDoa2400200","article-title":"Automated insulin delivery in older adults with type 1 diabetes","volume":"4","author":"Kudva","year":"2025","journal-title":"NEJM Evid"},{"issue":"12","key":"2026092920020569800_dgag344-B24","doi-asserted-by":"crossref","first-page":"2180","DOI":"10.2337\/dc23-0685","article-title":"Safety and efficacy of sustained automated insulin delivery compared with sensor and pump therapy in adults with type 1 diabetes at high risk for hypoglycemia: a randomized controlled trial","volume":"46","author":"Renard","year":"2023","journal-title":"Diabetes Care"},{"issue":"6","key":"2026092920020569800_dgag344-B25","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1089\/dia.2019.0018","article-title":"Hybrid closed-loop control is safe and effective for people with type 1 diabetes who are at moderate to high risk for hypoglycemia","volume":"21","author":"Anderson","year":"2019","journal-title":"Diabetes Technol Ther"},{"issue":"7","key":"2026092920020569800_dgag344-B26","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1089\/dia.2020.0593","article-title":"Impact of hybrid closed loop therapy on hypoglycemia awareness in individuals with type 1 diabetes and impaired hypoglycemia awareness","volume":"23","author":"Burckhardt","year":"2021","journal-title":"Diabetes Technol Ther"},{"issue":"3","key":"2026092920020569800_dgag344-B27","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1089\/dia.2017.0353","article-title":"Overnight glucose control with dual- and single-hormone artificial pancreas in type 1 diabetes with hypoglycemia unawareness: a randomized controlled trial","volume":"20","author":"Abitbol","year":"2018","journal-title":"Diabetes Technol Ther"},{"issue":"6","key":"2026092920020569800_dgag344-B28","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.1177\/19322968241245627","article-title":"Hybrid closed loop in adults with type 1 diabetes and severely impaired hypoglycemia awareness","volume":"19","author":"Lee","year":"2025","journal-title":"J Diabetes Sci Technol"},{"issue":"2","key":"2026092920020569800_dgag344-B29","doi-asserted-by":"crossref","first-page":"480","DOI":"10.2337\/dc19-1433","article-title":"Glucose and counterregulatory responses to exercise in adults with type 1 diabetes and impaired awareness of hypoglycemia using closed-loop insulin delivery: a randomized crossover study","volume":"43","author":"Lee","year":"2020","journal-title":"Diabetes Care"},{"issue":"3","key":"2026092920020569800_dgag344-B30","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1177\/1932296820986879","article-title":"The impact of a recently approved automated insulin delivery system on glycemic, sleep, and psychosocial outcomes in older adults with type 1 diabetes: a pilot study","volume":"16","author":"Bisio","year":"2022","journal-title":"J Diabetes Sci Technol"},{"issue":"2","key":"2026092920020569800_dgag344-B31","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1089\/dia.2021.0311","article-title":"Closed-loop insulin therapy in older adults with type 1 diabetes: real-world data","volume":"24","author":"Toschi","year":"2022","journal-title":"Diabetes Technol Ther"},{"key":"2026092920020569800_dgag344-B32","doi-asserted-by":"crossref","first-page":"110956","DOI":"10.1016\/j.diabres.2023.110956","article-title":"Safety and performance of a hybrid closed-loop insulin delivery system with carbohydrate suggestion in adults with type 1 diabetes prone to hypoglycemia","volume":"205","author":"Mesa","year":"2023","journal-title":"Diabetes Res Clin Pract"},{"key":"2026092920020569800_dgag344-B33","doi-asserted-by":"crossref","first-page":"110627","DOI":"10.1016\/j.diabres.2023.110627","article-title":"Switching to an advanced hybrid closed-loop system in real-world practice improves hypoglycemia awareness and metabolic control in adults with type 1 diabetes, particularly in those with impaired perception of hypoglycemia symptoms","volume":"199","author":"Nattero-Ch\u00e1vez","year":"2023","journal-title":"Diabetes Res Clin Pract"},{"issue":"6","key":"2026092920020569800_dgag344-B34","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.1177\/19322968231182406","article-title":"Prolonged use of an automated insulin delivery system improves sleep in long-standing type 1 diabetes complicated by impaired awareness of hypoglycemia","volume":"18","author":"Malone","year":"2024","journal-title":"J Diabetes Sci Technol"},{"issue":"7","key":"2026092920020569800_dgag344-B35","doi-asserted-by":"crossref","first-page":"2034","DOI":"10.1111\/dom.15055","article-title":"Advanced hybrid closed loop system use in elderly with type 1 diabetes: effectiveness and safety in a prospective, observational, 1-year follow-up real-world study","volume":"25","author":"Pintaudi","year":"2023","journal-title":"Diabetes Obes Metab"},{"issue":"2","key":"2026092920020569800_dgag344-B36","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1111\/dom.70302","article-title":"A nationwide 12-month observatory of automated insulin delivery shows improved glucose control, sustained adoption, and reduced acute severe events","volume":"28","author":"Riveline","year":"2026","journal-title":"Diabetes Obes Metab"},{"issue":"7","key":"2026092920020569800_dgag344-B37","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1089\/dia.2023.0061","article-title":"Time spent in hypoglycemia according to age and time of day: observations during closed-loop insulin delivery","volume":"25","author":"Alwan","year":"2023","journal-title":"Diabetes Technol Ther"},{"issue":"2","key":"2026092920020569800_dgag344-B38","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1111\/dom.15344","article-title":"Beneficial effects of automated insulin delivery over one-year follow-up in real life for youths and adults with type 1 diabetes irrespective of patient characteristics","volume":"26","author":"Henry","year":"2024","journal-title":"Diabetes Obes Metab"},{"issue":"1","key":"2026092920020569800_dgag344-B39","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1089\/dia.2023.0261","article-title":"Advanced hybrid closed-loop system achieves and maintains recommended time in range levels for up to 2 years: predictors of best efficacy","volume":"26","author":"Lepore","year":"2024","journal-title":"Diabetes Technol Ther"},{"issue":"1","key":"2026092920020569800_dgag344-B40","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1111\/dom.15996","article-title":"Long-term glycaemic improvement with the initiation of an automated insulin delivery system in insulin pump-na\u00efve older adults with type 1 diabetes","volume":"27","author":"Karakus","year":"2025","journal-title":"Diabetes Obes Metab"},{"issue":"5","key":"2026092920020569800_dgag344-B41","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1089\/dia.2020.0535","article-title":"A real-world prospective study of the safety and effectiveness of the loop open source automated insulin delivery system","volume":"23","author":"Lum","year":"2021","journal-title":"Diabetes Technol Ther"},{"issue":"10","key":"2026092920020569800_dgag344-B42","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1089\/dia.2022.0167","article-title":"A multicenter randomized trial evaluating fast-acting insulin aspart in the bionic pancreas in adults with type 1 diabetes","volume":"24","author":"Beck","year":"2022","journal-title":"Diabetes Technol Ther"},{"issue":"3","key":"2026092920020569800_dgag344-B43","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1089\/dia.2013.0166","article-title":"Feasibility of a portable bihormonal closed-loop system to control glucose excursions at home under free-living conditions for 48 hours","volume":"16","author":"van Bon","year":"2014","journal-title":"Diabetes Technol Ther"},{"issue":"6","key":"2026092920020569800_dgag344-B44","doi-asserted-by":"crossref","first-page":"e005243","DOI":"10.1136\/bmjdrc-2025-005243","article-title":"Disconnect between advanced diabetes technology and psychological well-being among young people: a cross-sectional analysis","volume":"13","author":"Ernst","year":"2025","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"S3","key":"2026092920020569800_dgag344-B45","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1089\/dia.2023.0505","article-title":"Decreasing the burden of carbohydrate counting and meal announcement with automated insulin delivery, meal recognition, and autocorrection doses: a case study","volume":"26","author":"Buckingham","year":"2024","journal-title":"Diabetes Technol Ther"},{"issue":"3","key":"2026092920020569800_dgag344-B46","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1111\/dom.70355","article-title":"Impact of stepwise diabetes technology advances in older adults with type 1 diabetes: a systematic review and meta-analysis of randomised trials","volume":"28","author":"Lei","year":"2026","journal-title":"Diabetes Obes Metab"}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgag344\/71468135\/dgag344.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgag344\/71468135\/dgag344.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:02:20Z","timestamp":1790726540000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/advance-article\/doi\/10.1210\/clinem\/dgag344\/8845738"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":46,"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgag344","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"dgag344"}}