TITLE:
Automated Insulin Delivery and Glycemic Control in the Gulf Region: A Contemporary Systematic Review of Clinical Outcomes
AUTHORS:
Talal Z. Alruwaili, Sabah Mustfa Tayfour Absher, Saud Saab Alanazi, Ahmed El-Malky, Mohammed Mosfer Alqahtani
KEYWORDS:
Automated Insulin Delivery, Closed-Loop Systems, Artificial Pancreas, Glycemic Control, Continuous Glucose Monitoring, Type 1 Diabetes, Hypoglycemia Prevention, Insulin Pump, Diabetes Technology, Patient Quality of Life, Algorithmic Insulin Dosing, Healthcare Accessibility, Data Privacy, Cybernetic Theory, Health Equity
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.15 No.4,
November
7,
2025
ABSTRACT: Automated Insulin Delivery (AID) systems have transformed diabetes management, offering more precise control over blood glucose levels by automating insulin administration. This systematic review aims to assess the effectiveness of AID systems on glycemic outcomes in the Gulf region, focusing on glycemic variability, hypoglycemia, patient satisfaction, and long-term health impacts. This systematic review followed PRISMA guidelines to evaluate the impact of Automated Insulin Delivery (AID) systems on glycemic control among diabetic patients in the Gulf region. We searched major databases, including PubMed and Embase, using a tailored strategy focused on relevant geographic and intervention terms. Studies published from 2020 onward were included, with strict eligibility criteria ensuring high-quality, region-specific data. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Meta-analysis was conducted where feasible, supplemented by narrative synthesis for heterogeneous data. Subgroup and sensitivity analyses further examined outcomes by diabetes type, age, and AID system type. This review analyzed 20 studies across Gulf countries, including Saudi Arabia, Kuwait, and the UAE, to assess insulin delivery systems for diabetes management during Ramadan fasting. Advanced technologies like continuous subcutaneous insulin infusion (CSII) and automated insulin delivery (AID) systems consistently outperformed traditional methods in glycemic control, hypoglycemia prevention, fasting adaptation, and patient satisfaction. CSII reduced HbA1c by 1.3% compared to MDI, and AID ensured 89% fasting continuity. Hypoglycemia rates were 7% with CSII versus 15% with MDI. Remote-controlled pumps achieved higher satisfaction (87%) than MDI (63%). The findings underscore integrating advanced technologies into diabetes care for optimal outcomes. Advanced insulin delivery systems, including CSII and AID, demonstrate superior efficacy in glycemic control, hypoglycemia prevention, fasting adaptation, and patient satisfaction during Ramadan. These technologies significantly enhance diabetes management outcomes, emphasizing their integration into routine care. Future research should validate these findings through larger, multicenter trials across diverse populations.