Automated Insulin Delivery Systems in Pediatric Type 1 Diabetes: From Real-World Evidence to Future Perspectives

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Endocrinology".

Deadline for manuscript submissions: 28 February 2026 | Viewed by 627

Special Issue Editors


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Guest Editor
Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina Italy
Interests: type 1 diabetes; pediatrics; children; allergy
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
Interests: type 1 diabetes; mellitus pediatrics; diabetes technology; diabetes epidemiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Automated insulin delivery (AID) systems represent a major advancement in the management of type 1 diabetes. Over the past decade, technological innovations have evolved from predictive low-glucose suspend systems to advanced hybrid closed-loop algorithms, significantly improving glycemic control and quality of life in children and adolescents. Despite regulatory approvals and clinical trial success, real-world adoption, psychological implications, predictors of therapeutic success, and long-term outcomes in the pediatric population remain areas of active investigation and clinical relevance.

The goal of this Special Issue is to offer an up-to-date, multidisciplinary overview of AID systems in the pediatric type 1 diabetes population. By focusing on both clinical and psychosocial dimensions, the issue aims to critically assess real-world implementation, identify factors influencing therapeutic success, and discuss barriers to long-term sustainability. We intend to bring together contributions that reflect the complexity of pediatric care, encompassing technological innovation, patient and caregiver experiences, and health system integration. This Special Issue will serve as a resource for clinicians, researchers, and policymakers seeking to optimize AID use and equity in care delivery for children and adolescents with type 1 diabetes.

It will also explore the integration of AID with digital health tools and precision medicine approaches.

We welcome original research, clinical trials, real-world evidence studies, reviews, commentaries, and expert perspectives. Submissions addressing global diversity, health disparities, and innovations in pediatric diabetes technology are especially encouraged.

Dr. Stefano Passanisi
Dr. Bruno Bombaci
Guest Editors

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Keywords

  • adolescents
  • algorithm
  • children
  • insulin pump
  • nutrition
  • patient-reported outcomes
  • quality of life

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Published Papers (1 paper)

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Research

11 pages, 590 KB  
Article
Impact of Automated Insulin Delivery Systems in Children and Adolescents with Type 1 Diabetes Previously Treated with Multiple Daily Injections: A Single-Center Real-World Study
by Bruno Bombaci, Marco Calderone, Alessandra Di Pisa, Mariarosaria La Rocca, Arianna Torre, Fortunato Lombardo, Giuseppina Salzano and Stefano Passanisi
Medicina 2025, 61(9), 1602; https://doi.org/10.3390/medicina61091602 - 5 Sep 2025
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Abstract
Background and Objectives: Automated insulin delivery (AID) systems represent a major advancement in type 1 diabetes (T1D) management, particularly in pediatric populations. However, real-world evidence comparing their effectiveness to conventional multiple daily injection (MDI) therapy in youth remains limited. This study aimed [...] Read more.
Background and Objectives: Automated insulin delivery (AID) systems represent a major advancement in type 1 diabetes (T1D) management, particularly in pediatric populations. However, real-world evidence comparing their effectiveness to conventional multiple daily injection (MDI) therapy in youth remains limited. This study aimed to evaluate the impact of transitioning from MDI therapy to AID systems on glycemic control in children and adolescents with T1D, and to explore potential differences based on baseline HbA1c levels and device type. Materials and Methods: In this single-center, retrospective observational study, 76 children and adolescents with T1D were evaluated before and after switching from MDI to either the Medtronic MiniMed™ 780G or Tandem t:slim X2™ Control-IQ system. Glycemic control was assessed using continuous glucose monitoring (CGM)-derived metrics at three time points: the last 15 days of MDI therapy (T0), 15 days after (T1), and 6 months after (T2) AID initiation. Statistical comparisons were conducted across time points and between subgroups stratified by baseline HbA1c and AID system. Results: Significant improvements in glycemic control were observed as early as 15 days after AID initiation, with sustained benefits at 6 months. Time in range (TIR) increased from 62.0% at baseline to 76.7% at 15 days and 75.8% at 6 months, and time in tight range (TITR) from 39.8% to 53.9% at T1 and 52.1% at T2 (both p < 0.001). Improvements were more pronounced in participants with higher baseline HbA1c (+16.9% for TITR and +22.3% for TIR). No significant differences in glycemic outcomes were observed between device groups, although algorithm-driven differences in insulin delivery patterns were noted. Total daily insulin dose and BMI increased significantly over time (p < 0.001 and p = 0.008, respectively). Conclusions: AID therapy leads to rapid and sustained improvements in glycemic control among youth with T1D, particularly in those with suboptimal baseline control. These benefits highlight the clinical value of AID systems, while also emphasizing the need for monitoring potential metabolic impacts. Full article
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