Device-supported automated basal insulin titration in adults with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

Yingying Luo, Yaping Chang, Zhan Zhao, Jun Xia, Chenchen Xu, Yong Mong Bee, Xiaoying Li, Wayne H.H. Sheu, Margaret McGill, Siew Pheng Chan, Marisa Deodat, Ketut Suastika, Khue Nguyen Thy, Liming Chen, Alice Pik Shan Kong, Wei Chen, Chaicharn Deerochanawong, Daisuke Yabe, Weigang Zhao, Soo LimXiaomei Yao, Linong Ji

Research output: Journal PublicationArticlepeer-review

1 Citation (Scopus)


Background: Technological advances make it possible to use device-supported, automated algorithms to aid basal insulin (BI) dosing titration in patients with type 2 diabetes. Methods: A systematic review and meta-analysis of randomized controlled trials were performed to evaluate the efficacy, safety, and quality of life of automated BI titration versus conventional care. The literature in Medline, Embase, Web of Science, and the Cochrane databases from January 2000 to February 2022 were searched to identify relevant studies. Risk ratios (RRs), mean differences (MDs), and their 95% confidence intervals (CIs) were calculated using random-effect meta-analyses. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Findings: Six of the 7 eligible studies (889 patients) were included in meta-analyses. Low- to moderate-quality evidence suggests that patients who use automated BI titration versus conventional care may have a higher probability of reaching a target of HbA1c <7.0% (RR, 1.82 [95% CI, 1.16–2.86]); and a lower level of HbA1c (MD, −0.25% [95% CI, −0.43 to −0.06%]). No statistically significant differences were detected between the two groups in fasting glucose results, incidences of hypoglycemia, severe or nocturnal hypoglycemia, and quality of life, with low to very low certainty for all the evidence. Interpretation: Automated BI titration is associated with small benefits in reducing HbA1c without increasing the risk of hypoglycemia. Future studies should explore patient attitudes and the cost-effectiveness of this approach. Funding: Sponsored by the Chinese Geriatric Endocrine Society.

Original languageEnglish
Article number100746
JournalThe Lancet Regional Health - Western Pacific
Publication statusPublished - Jun 2023


  • Automated titration
  • Basal insulin
  • Glucose control
  • HbA level
  • Hypoglycemia
  • Systematic review
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Pediatrics, Perinatology, and Child Health
  • Health Policy
  • Obstetrics and Gynaecology
  • Public Health, Environmental and Occupational Health
  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • Infectious Diseases


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