Abstract
Automated insulin delivery (AID) systems have revolutionized diabetes care by integrating continuous glucose monitoring, insulin pumps, and advanced algorithms to improve glycemic outcomes and reduce user burden. Early commercial AID systems were developed with a conservative approach, prioritizing safety and regulatory approval over full automation or extensive customization. While these systems significantly improved diabetes management, they still face limitations, including incomplete automation, accessibility barriers, and the need for better adaptation to diverse user needs and lifestyles. These challenges are now catalyzing development of next-generation AID technologies with a focus on achieving full automation, greater personalization, and broader accessibility. This review examines key limitations of current AID systems and explores future directions, including fully closed-loop control, novel insulin formulations, multi-hormonal systems, advanced sensor technologies, and integration of wearable and artificial intelligence tools. By addressing these challenges, future AID systems have the potential to deliver better effectiveness and equity in diabetes care for all individuals requiring insulin therapy.