Early Consideration of Automated Insulin Delivery in Type 2 Diabetes: A Critical Review.
TL;DR
Randomized and real-world studies demonstrate that AID systems significantly improve A1C and time in range while minimizing hypoglycemia, without increasing treatment complexity or patient burden, and position AID as a practical and effective strategy to overcome long-standing therapeutic inertia in type 2 diabetes.
Abstract
Despite major advances in therapeutics, many adults with type 2 diabetes do not achieve recommended glycemic targets, driven by progressive beta cell dysfunction and persistent therapeutic inertia. Insulin therapy is commonly delayed for years, exposing patients to prolonged hyperglycemia and substantially increasing complication risks. Although automated insulin delivery (AID) systems have transformed outcomes for people with type 1 diabetes, their adoption in type 2 diabetes has been limited. Emerging evidence and recent updates to the American Diabetes Association Standards of Care now support AID as the preferred insulin delivery method for adults with type 2 diabetes on multiple daily injections of insulin or for whom basal-only insulin is not sufficient to achieve glycemic targets, reflecting a paradigm shift toward addressing the burdens and limitations of manual insulin delivery. Randomized and real-world studies demonstrate that AID systems significantly improve A1C and time in range while minimizing hypoglycemia, without increasing treatment complexity or patient burden. By dynamically adapting insulin delivery to real-time continuous glucose monitoring data, AID mitigates common barriers to intensification, including fear of hypoglycemia and increased regimen complexity associated with multiple daily injections. In addition, AID enables more efficient diabetes care through standardized glucose reporting, remote data review, and team-based management. Together, these advances position AID as a practical and effective strategy to overcome long-standing therapeutic inertia in type 2 diabetes. Earlier consideration of AID during insulin intensification could improve glycemic outcomes, reduce diabetes-related complications, decrease cognitive burden, and modernize insulin delivery for people living with type 2 diabetes.