Introduction and Objective: While closed-loop (CL) technology has transformed outpatient diabetes care, evidence in acute settings is limited. This systematic review and meta-analysis (PROSPERO: CRD420251133486) evaluated the safety, efficacy, and implementation of closed-loop technology in acute care.Methods: Eligible studies included adults managed with CL in acute care reporting glycaemic, safety, and implementation outcomes compared with standard care. EMBASE, PubMed, MEDLINE, Scopus, CINAHL and Cochrane CENTRAL were searched from inception to November 2025. Risk of bias was assessed using RoB2 and ROBINS-I tools. Random-effects meta-analysis evaluated glycaemic outcomes and length of stay (LOS). Results were presented as pooled mean difference (pMD) and 95% confidence intervals (CI). Implementation data were analysed thematically.Results: Of 27448 records identified, 10 studies (n=437 patients) were included. Meta-analysis of 6 studies (n=326) showed improved glycaemic control with CL systems over standard care: lower mean glucose (pMD: -1.71mmol/L, CI: -2.15,-1.28; p<.01), increased time in range (pMD: +24.5%, CI: 20.7,28.4; p<.01), reduced time above range (pMD: -24.1%, CI: -28.7,-19.6; p<.01), lower glycaemic variability (pMD: -0.71 mmol/L, CI: -0.90,-0.52; p<.01), and reduced coefficient of variation (pMD: -3.22%, CI: -4.92,-1.53; p<.01) of glucose concentration, with no observed heterogeneity (I² = 0%). There was no significant difference in time below range (pMD: +0.90%, CI: -1.59,3.39; p=0.48) or LOS (pMD: -1.49, CI: -3.11,0.14; p=0.07). 82 device adverse events were reported, mainly sensor failures or site-related. There were no intervention-related deaths or severe hypoglycaemia. Key implementation themes were staff training feasibility, patient and staff acceptability and fidelity, workflow integration, and infrastructure constraints.Conclusion: Closed-loop technology is safe and effective in acute care, with no significant impact on LOS. Successful implementation depends on institutional infrastructure and staff training.
V. Gupta: None. K. Persad: None. A. Ling Jie Yee: None. E. Armeni: Speaker’s Bureau; Ended; Androlabs. Advisory Panel; Ended; Bezins Healthcare. A. Manta: None. P. Kempegowda: None.
National Institute of Health and Social Care Research (NIHR-303671)
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