Improving Pediatric Glycemic Control with Smart Insulin Pens: The Current Trends and Future Prospects.

Abstract

Pediatric diabetes management remains challenging, as many young patients struggle to hit glycemic targets due to developmental factors and treatment burdens. Smart insulin pens are a game-changing "connected MDI" alternative, with "pump-like" features such as bolus calculators and automated Insulin-on-Board tracking for non-pump users. This review explores the clinical effectiveness, economic impact, and prospects of SIPs in pediatrics, including patient and caregiver insights and long-term effects on glycemic control. Caregivers and patients agree SIPs are accessible and easy to use due to user-friendly interfaces, data-driven approaches, and remote monitoring. Evidence shows SIPs improve safety and adherence, with a 31.4% reduction in daily hypoglycemia, a 24.4% decrease in nocturnal hypoglycemia, and a drop in Time Below Range Level 2 from 2.82% to 2.18%. By tracking insulin-on-board, SIPs prevent insulin stacking and enable safe correction doses; users correcting within three hours of a previous dose spend more time in range without increased hypoglycemia. SIPs also cut missed boluses by up to 43% in youth. Economically, SIPs save about SEK 124,270 per patient by delaying complications. However, adoption remains limited due to socioeconomic barriers, with 82% of clinics citing insurance issues and lower use among Medicaid beneficiaries. Barriers include the learning curve and device costs, which can be addressed through subsidies and training programs. Future AI developments, like hypoglycemia prediction, promise to further personalize pediatric care. Overall, SIPs benefit pediatric diabetes management, but more research, including clinical trials, is needed to confirm optimal outcomes.