A Systematic Review and Metanalysis on the Impact of Automated Insulin Delivery Systems on Body Mass Index in Youths with Type 1 Diabetes and Potential Predictors

Aims: To systematically assess the impact of automated insulin delivery (AID) systems on body mass index(BMI), weight, and body composition and to analyze potential associations with the total daily, basal, and %of autocorrection insulin doses.Materials and Methods: We performed this review through systematic searches of Pubmed, EMBASE, TheCochrane Library, Web of Science, Clinicaltrials.gov, and the International Clinical Trials Registry Platformbetween September 1, 2015, and September 1, 2024. PICOS framework was used in the selection process,and summary outcome data were provided for each study. A meta-analysis determined the impact of BMIz-score and total daily insulin (TDI) pro-Kg increase. We used the GRADE approach to rank the quality of evi-dence. This study was registered with PROSPERO, CRD42024613557.Results: A total of 161 studies were identified after duplicate removal, and 18 were included. According tostudies with moderate quality evidence (No. 13), the meta-analysis revealed an unchanged BMI z-score after1-year follow-up with AID: 0.0174 (95% confidence interval [CI]: -0.095 to 0.130), despite the increase inTDI: 0.54 U/Kg per day (95% CI: 0.34 to 0.75), mainly due to the autocorrection boluses.Conclusions: Evidence confirms the importance of educating youths with type 1 diabetes using AIDs andtheir families about healthy diet composition and carbohydrate intake. However, these systems also improveglucose control in subjects who are less accurate with bolus at meals without an impact on BMI z-score.