Automated Insulin Delivery Systems: Impact on Clinical Practice, Discontinuation, Rejection, and Reasons for Not Managing Well

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Abstract
Background: Automated insulin delivery (AID) systems can significantly improve glycemic outcomes in people with type 1 diabetes (PWT1D). Despite their clinical efficacy, little is known about their uptake in clinical care, or about the perspectives and experiences of health care professionals (HCPs) and people with diabetes (PWD) with this relatively new technology. Furthermore, research is limited on broader populations, such as people with type 2 diabetes (PWT2D) and cross-country comparisons. Methods: This study analyzes data from the dt-report 2025, a multinational online survey of PWD and HCPs from Germany, Austria, Switzerland, and Spain, which was conducted at the end of 2024. The surveys assessed, among others, AID relevance, indications, barriers, daily use, satisfaction, and support needs. Results: In total, 1294 HCPs and 2535 PWD from Germany, Austria, Switzerland, and Spain took part. Health care professionals identified fully closed-loop systems as the most promising future therapy. While 90% of PWT1D were seen as candidates for AID therapy, 55% of PWT2D on intensified insulin therapy were also considered likely to benefit. Nonetheless, 22% of eligible PWD rejected AID, citing device burden and general concerns regarding its usability. Health care professionals reported a discontinuation rate of 8%. Satisfaction with AID was generally high. Regression analyses identified technical problems, lack of trust, and unrealistic expectations as significant predictors of lower satisfaction and poorer management in PWD. Conclusion: Despite increasing user rates of AID systems, a significant proportion reports problems in managing this technology or aborting its use. Addressing reasons for this may increase the uptake in clinical care. There was also a positive view of HCPs on AID use in PWT2D.

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