EMERGING TECHNOLOGIES IN DIABETES MANAGEMENT: FROM CONTINUOUS GLUCOSE MONITORING (CGM) TO THE ARTIFICIAL PANCREAS (2015–2025)
Abstract
Introduction: Over the past decade, diabetes care has undergone a profound technological transformation. Continuous glucose monitoring (CGM), intermittently scanned glucose monitoring systems (isCGM/flash), sensor-integrated insulin pumps, and hybrid closed-loop systems (“artificial pancreas”) have become central components of modern management of type 1 diabetes and are increasingly used in selected forms of insulin-treated type 2 diabetes.
Objective: To present a literature review from 2015–2025 on emerging technologies in diabetes treatment—from CGM to artificial pancreas systems—with particular emphasis on clinical effectiveness, psychosocial impact, and social and health-system implications.
Methods: A narrative review of the literature published between 2015 and 2025, identified through searches of PubMed/MEDLINE and the Cochrane Library, as well as leading diabetology and endocrinology journals. The review included randomized controlled trials, real-world observational studies, meta-analyses, systematic reviews, and position statements from scientific societies (ADA, EASD, ISPAD, ATTD).
Results: Compared with conventional self-monitoring of blood glucose (SMBG), CGM and isCGM systems significantly reduce HbA1c levels, time spent in hypoglycaemia, and glycaemic variability, while increasing time in range (TIR). Hybrid closed-loop systems further improve TIR (often exceeding 70–75%), reduce both hypo- and hyperglycaemia, and are associated with high patient satisfaction. Telemedicine and cloud-based platforms enable remote monitoring and support new models of care. Key barriers include cost, limited reimbursement, variability in digital literacy, and inequalities in access.
Conclusions: Emerging technologies—from CGM and isCGM to hybrid closed-loop systems—represent a major step toward individualized and partially automated diabetes management. To fully realize their potential, equitable access, adequate funding, structured education, and integration with digital health tools and psychosocial support are essential.
References
American Diabetes Association. (2022). Standards of medical care in diabetes—Section on diabetes technology. Diabetes Care, 45(Suppl. 1), S97–S112. https://doi.org/10.2337/dc22-S007
American Diabetes Association. (2023). Diabetes technology: Standards of medical care in diabetes—2023. Diabetes Care, 46(Suppl. 1), S111–S127. https://doi.org/10.2337/dc23-S007
Battelino, T., Danne, T., Bergenstal, R. M., et al. (2019). Clinical targets for continuous glucose monitoring data interpretation: Recommendations from the international consensus on time in range. Diabetes Care, 42(8), 1593–1603. https://doi.org/10.2337/dc19-1632
Battelino, T., Danne, T., Bergenstal, R. M., et al. (2020). Clinical use of time in range: A consensus statement. Diabetes Care, 43(7), 1496–1503. https://doi.org/10.2337/dci20-0028
Beck, R. W., et al. (2017). Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections. JAMA, 317(4), 371–378. https://doi.org/10.1001/jama.2016.19975
Bolinder, J., et al. (2016). Novel flash glucose-monitoring technology in type 1 diabetes: A randomized controlled trial. The Lancet, 388(10057), 2254–2263. https://doi.org/10.1016/S0140-6736(16)31535-5
Breton, M. D., et al. (2020). A randomized trial of closed-loop control in children with type 1 diabetes. The New England Journal of Medicine, 383(9), 836–845. https://doi.org/10.1056/NEJMoa2004731
Brown, S. A., et al. (2019). Six-month randomized, multicenter trial of closed-loop control in type 1 diabetes. The New England Journal of Medicine, 381(18), 1707–1717. https://doi.org/10.1056/NEJMoa1907863
Charleer, S., et al. (2018). Quality of life and fear of hypoglycemia in adults with type 1 diabetes using flash glucose monitoring. Diabetes Care, 41(7), 1406–1413. https://doi.org/10.2337/dc17-2449
Danne, T., et al. (2017). International consensus on use of continuous glucose monitoring. Diabetes Care, 40(12), 1631–1640. https://doi.org/10.2337/dc17-1600
de Boer, I. H., et al. (2019). Diabetes management in the era of value-based care and digital health. Diabetologia, 62(3), 393–402. https://doi.org/10.1007/s00125-018-4770-3
Farmer, A. J., et al. (2019). Telemedicine and digital technologies in diabetes care. Diabetic Medicine, 36(4), 444–451. https://doi.org/10.1111/dme.13987
Grudziąż-Sękowska, J., et al. (2025). Effectiveness of hybrid closed-loop systems in pediatric type 1 diabetes mellitus management: A systematic review. Health Problems of Civilization, 19(1), 1–10. https://doi.org/10.5114/hpc.2025.151047
Haak, T., et al. (2017). Flash glucose monitoring improves glycemic control and quality of life. Diabetes Therapy, 8(1), 55–73. https://doi.org/10.1007/s13300-016-0223-6
Heinemann, L., Freckmann, G., Ehrmann, D., et al. (2018). Benefits and limitations of technology in the management of diabetes. The Lancet Diabetes & Endocrinology, 6(2), 93–95. https://doi.org/10.1016/S2213-8587(17)30392-2
International Diabetes Federation. (2021). IDF diabetes atlas (10th ed.). International Diabetes Federation.
Jeitler, K., et al. (2018). Continuous glucose monitoring in type 1 diabetes: A meta-analysis. Diabetologia, 61(8), 1590–1599. https://doi.org/10.1007/s00125-018-4633-1
Jiao, X., Shen, Y., & Chen, Y. (2022). Better TIR, HbA1c, and less hypoglycemia in closed-loop insulin system in patients with type 1 diabetes: A meta-analysis. BMJ Open Diabetes Research & Care, 10(2), e002633. https://doi.org/10.1136/bmjdrc-2021-002633
Jiao, X., Zhang, L., Chen, Y., Li, P., & Wang, H. (2023). Better time in range, HbA1c, and less hypoglycemia in closed-loop insulin systems: A meta-analysis. Journal of Diabetes Clinical Research, 15(2), 101–115. https://doi.org/10.1136/bmjdrc-2021-002633
Lane, W., et al. (2019). Use of continuous glucose monitoring in adults with type 2 diabetes on basal insulin: A randomized clinical trial. Diabetes Care, 42(8), 1630–1637. https://doi.org/10.2337/dc18-1725
Ly, T. T., et al. (2017). Reducing hypoglycemia in type 1 diabetes using sensor-augmented pump therapy with predictive low-glucose management. Diabetes Care, 40(6), 778–785. https://doi.org/10.2337/dc16-1355
Martens, T., et al. (2021). Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin. JAMA, 325(22), 2262–2272. https://doi.org/10.1001/jama.2021.6784
McAuley, S. A., et al. (2020). Hybrid closed-loop therapy in adults with type 1 diabetes: A randomized controlled trial. Diabetologia, 63(11), 2154–2164. https://doi.org/10.1007/s00125-020-05234-w
Mirasghari, F., et al. (2024). Challenges of using telemedicine for patients with diabetes during the COVID-19 pandemic. Diabetes Research and Clinical Practice, 206, 110012. https://doi.org/10.1016/j.diabres.2024.110012
Oskarsson, P., et al. (2018). Impact of flash glucose monitoring on hypoglycemia in adults with type 1 diabetes. Diabetes, Obesity and Metabolism, 20(3), 543–552. https://doi.org/10.1111/dom.1314
Papazafiropoulou, A. (2022). Telemedicine and diabetes during the COVID-19 era. Archives of Medical Science – Atherosclerotic Diseases, 7(1), 131–135. https://doi.org/10.5114/amsad.2022.116662
Piya, M. K., et al. (2020). Diabetes technology and psychosocial outcomes. Current Diabetes Reports, 20(5), 16. https://doi.org/10.1007/s11892-020-01317-w
Prahalad, P., et al. (2018). Use of “do-it-yourself” artificial pancreas systems in children with type 1 diabetes. Diabetes Care, 41(4), e58–e59. https://doi.org/10.2337/dc17-1510
Rodriguez-Gutierrez, R., et al. (2019). Digital health interventions in diabetes: A systematic review. BMJ Open, 9(3), e023104. https://doi.org/10.1136/bmjopen-2018-023104
Rosta, L., et al. (2023). Telemedicine for diabetes management during COVID-19: Opportunities and challenges. Frontiers in Endocrinology, 14, 1129793. https://doi.org/10.3389/fendo.2023.1129793
Seidu, S., et al. (2022). Cost-effectiveness of continuous glucose monitoring versus self-monitoring of blood glucose in people with type 1 diabetes: A systematic review. Endocrinology, Diabetes & Metabolism, 5(6), e00369. https://doi.org/10.1002/edm2.369
Seidu, S., et al. (2024). Efficacy and safety of continuous glucose monitoring and intermittently scanned CGM in people with type 2 diabetes: A systematic review and meta-analysis. Diabetes Care, 47(1), 169–181. https://doi.org/10.2337/dc23-0814
Sherr, J. L., et al. (2018). ISPAD clinical practice consensus guidelines 2018: Diabetes technologies. Pediatric Diabetes, 19(Suppl. 27), 302–325. https://doi.org/10.1111/pedi.12716
Sun, H., Saeedi, P., Karuranga, S., et al. (2022). IDF diabetes atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Research and Clinical Practice, 183, 109119. https://doi.org/10.1016/j.diabres.2021.109119
Teo, E., et al. (2022). Effectiveness of continuous glucose monitoring in improving glycemic control in type 1 diabetes: A systematic review and meta-analysis. Diabetologia, 65(12), 2101–2114. https://doi.org/10.1007/s00125-022-05832-3
Wadwa, R. P., et al. (2023). Hybrid closed-loop therapy in very young children with type 1 diabetes. The New England Journal of Medicine, 388(5), 123–132. https://doi.org/10.1056/NEJMoa2204142
Weinstock, R. S., et al. (2017). Effect of continuous glucose monitoring on hypoglycemia in adults with type 1 diabetes and impaired hypoglycemia awareness. Diabetes Care, 40(4), 538–545. https://doi.org/10.2337/dc16-1908
Welsh, J. B., et al. (2019). Continuous glucose monitoring and metrics of glycemic control. Journal of Diabetes Science and Technology, 13(4), 664–673. https://doi.org/10.1177/1932296819859840
World Health Organization. (2023). Diabetes. https://www.who.int/news-room/fact-sheets/detail/diabetes
Young-Hyman, D., et al. (2016). Psychosocial care for people with diabetes: A position statement of the American Diabetes Association. Diabetes Care, 39(12), 2126–2140. https://doi.org/10.2337/dc16-2053
Ziegler, R., et al. (2020). Telemedicine in pediatric diabetes care: Benefits and limitations. Pediatric Diabetes, 21(5), 707–718. https://doi.org/10.1111/pedi.13002
Zisser, H., et al. (2019). Automated insulin delivery systems: Current status and future directions. Diabetes Technology & Therapeutics, 21(Suppl. 2), S13–S24. https://doi.org/10.1089/dia.2019.0113
Zou, D., et al. (2021). Artificial intelligence in diabetes technology. Journal of Diabetes Science and Technology, 15(2), 284–294. https://doi.org/10.1177/1932296821993018
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