The effect of automated insulin delivery system use on diabetes distress in people with type 1 diabetes and their caregivers: A systematic review and meta-analysis

Aims: Diabetes distress (DD) is prevalent among people with diabetes. While automated insulin delivery systems (AIDs) improve glycaemic control, their impact on DD is unclear. We aimed to investigate the effect of AIDs on DD in people with diabetes and their caregivers. Methods: We focused on people with diabetes using AIDs versus other insulin delivery systems, with DD as the outcome. We included randomised controlled trials (RCTs), before-after studies (BAS) and observational studies until 4 April 2024. After screening, 40 studies were included in the systematic review, comprising 5426 participants (3210 adults, 1131 paediatric and 1085 caregivers). Twenty-seven studies were selected for the meta-analysis (focusing solely on type 1 diabetes). We used random effects models by population and study design. We also conducted a subgroup analysis by age group (children vs. teenagers). Results: In adults, eight BAS and five RCTs indicated a significant small DD reduction post-AID initiation (standardised mean difference [95% confidence intervals] −0.32 [95% CI: −0.40, −0.24] and [−0.19 (−0.27, −0.11)]). No significant changes were observed in the paediatric population. In caregivers, eleven BAS and five RCTs indicated a significant moderate DD reduction (−0.48 [95% CI: −0.78, −0.18] and (−0.22 [−0.38, −0.06])). Subgroup analysis revealed an increased benefit in parents of children compared to parents of teenagers. Conclusions: This work suggests that AIDs is associated with a DD reduction in adults and caregivers but not in children/teenagers with type 1 diabetes. More longitudinal studies and better systematic DD assessments are needed.