Diabetes technology in type 2 diabetes care

Diabetes technologies, including continuous glucose monitoring (CGM), smart insulin pens, automated insulin delivery (AID), and digital health applications (“apps”), are increasingly used in the management of type 2 diabetes (T2D), although access to and use of these technologies in routine care vary across regions and healthcare settings. However, their role across the broader cardiometabolic spectrum—such as in intermediate hyperglycemia and obesity—remains less defined. In this narrative review, the available evidence on the efficacy and acceptability of modern technology across the heterogeneous spectrum of T2D is critically examined. Evidence of varying strength demonstrates that current technologies improve glycemic outcomes in T2D while facilitating treatment intensification and improving patient-reported outcomes, particularly when embedded in structured, often innovative, education approaches. Major improvements have been reported with CGM and AID systems, while smart insulin pens provide additional benefit by recording, monitoring, and transmitting dosing data, thereby supporting treatment adherence and optimization. Emerging real-world evidence further suggests that CGM can elicit favorable effects on cardiovascular outcomes and mortality. Apps primarily serve as supportive tools, enhancing data integration, education, and remote care within CGM/AID-based management, although evidence supporting their clinical efficacy is still evolving, as many studies are short-term and small-scale. Conversely, evidence for CGM use in intermediate hyperglycemia (prediabetes) and obesity remains limited, as no universally accepted CGM-derived diagnostic thresholds, risk scores, or intervention algorithms have been established. Future advances will require validation of CGM-derived metrics and integration of glucose data with clinical, genetic, and behavioral information, as well as artificial intelligence (AI)-supported interpretation to provide more precise cardiometabolic risk assessment and care. Addressing interoperability, regulatory, and reimbursement challenges, alongside barriers to access and workforce education, will be essential for the equitable integration of diabetes technologies into clinical practice.