Effects of Modern Glucose Monitoring and Insulin Delivery Technologies on Patient-Reported Outcomes and Experiences in Individuals With Type 1 Diabetes: A Systematic Review and Meta-analysis.

Abstract

Use of technology is central to the management of type 1 diabetes (T1D), while patient reported outcomes measures (PROMs) can support in the management of these individuals. To assess the effect of diabetes technologies on patient-reported outcome measures (PROMs) in type 1 diabetes (T1D). Cochrane Library CENTRAL, Embase, MEDLINE, Scopus, and Web of Science were searched for relevant articles from 2013 to August 2025. We included longitudinal diabetes technology studies assessing validated PROMs in nonpregnant adults with T1D. Study characteristics and PROM data were extracted, and standardized mean differences (SMDs) for PROs were pooled using a random-effects meta-analysis. We identified 4,885 articles, comprising 81 independent studies (n = 19,148 participants) and 70 different PROMs. The Hypoglycemia Fear Survey (HFS) was most commonly used (k = 39 studies), followed by the Diabetes Treatment Satisfaction Questionnaire (status [DTSQs] or change version [DTSQc]; k = 38), Diabetes Distress Scale (DDS; k = 25), and Problem Areas in Diabetes (PAID) scale (k = 24). Technology use was associated with lower HFS total score compared with control (SMD -0.177; 95% CI -0.319, -0.036; P = 0.014; I2 = 0.0%), with the largest effect observed in automated insulin device users. A moderate positive effect of diabetes technologies was observed on DTSQs and DTSQc scores (SMD 0.429; 95% CI 0.206, 0.653; P < 0.001; I2 = 72.3%), with a small to moderate reduction in DDS and PAID scores (SMD -0.265; 95% CI -0.363, -0.166; P < 0.001; I2 = 0.0%). Differences in type of technology, varied use and incomplete reporting of PROMs, and different duration of studies. Diabetes technologies offer psychological benefits in adults with T1D. The large number of reported PROMs suggests a need to standardize their use.