A systematic review and meta-analysis of randomised controlled trials comparing Artificial Pancreas systems (insulin only or insulin plus glucagon) with conventional pump therapy [CSII] with blinded CGM or unblinded sensor-augmented pump [SAP] therapy in adults and children with type 1 diabetes uniformly improved glucose control in outpatient settings with Artificial Pancreas systems.

27 comparisons from 24 studies (23 crossover and one parallel design) including a total of 585 participants were eligible for analysis. Five comparisons assessed dual-hormone (insulin and glucagon), two comparisons assessed both dual-hormone and single-hormone (insulin only), and 20 comparisons assessed single-hormone Artificial Pancreas systems.

Time in target was 12.59% higher with Artificial Pancreas systems (95% CI 9.02–16.16; p<0.0001), from a weighted mean of 58.21% for conventional pump therapy (I2=84%).

Dual-hormone Artificial Pancreas systems were associated with a greater improvement in time in target range compared with single-hormone systems (19.52% [95% CI 15.12–23.91] vs 11.06% [6.94 to 15.18]; p=0.006), although six of seven comparisons compared dual-hormone systems to CSII with blinded CGM, whereas 21 of 22 single-hormone comparisons had SAP as the comparator.

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