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Closed-loop insulin delivery for glycaemic control in hospitalised and perioperative adults: A systematic review and meta-analysis of randomised controlled trials.

Jinzhi Zhong·Chan Zhao·Xu Shuai·Hebin Wang·Rui Qi·Shenjiao Yang·Lve Cheng
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Abstract

We evaluated whether closed-loop insulin delivery improves glycaemic control in hospitalised and perioperative adults. PubMed/MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched from inception to 29 June 2026 for randomised controlled trials comparing closed-loop or automated insulin delivery with usual care or conventional insulin therapy. Random-effects meta-analyses were conducted; risk of bias was assessed using RoB 2 and certainty of evidence using GRADE. Seven trials involving 375 analysed participants were included. Closed-loop insulin delivery increased time in target glucose range by 23.91 percentage points (95% CI 19.40 to 28.43; I2 = 0%) and reduced mean glucose by 1.79 mmol/L (95% CI 1.06 to 2.53 lower; I2 = 36.3%); certainty was moderate for both outcomes. Two trials involving 69 participants reported compatible participant-level data for clinically significant hyperglycaemia, and both estimates favoured closed-loop insulin delivery, although the evidence was exploratory and imprecise. No severe hypoglycaemic events occurred in either group, precluding reliable estimation of comparative safety. Closed-loop insulin delivery may improve glycaemic process measures, but larger pragmatic trials are needed to establish clinical benefits, safety, and implementation feasibility.

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HumansInsulinGlycemic ControlRandomized Controlled Trials as TopicInsulin Infusion SystemsHypoglycemic AgentsBlood GlucoseAdultPerioperative CareHospitalizationHyperglycemiaArtificial pancreasAutomated insulin deliveryClosed-loop insulin deliveryHospitalisationPerioperative careTime in rangeJournal ArticleSystematic ReviewMeta-AnalysisReview

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Jinzhi Zhong, Chan Zhao, Xu Shuai, Hebin Wang, Rui Qi, Shenjiao Yang, Lve Cheng. 2026-08-25. Closed-loop insulin delivery for glycaemic control in hospitalised and perioperative adults: A systematic review and meta-analysis of randomised controlled trials.. https://doi.org/10.1016/j.diabres.2026.113519

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Adult subjectBlood Glucose subjectHospitalization subjectHumans subjectJournal Article subjectJournal Article; Systematic Review; Meta-Analysis; Review resourceMeta-Analysis subjectPerioperative Care subjectSystematic reviews study

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