Continuous glucose monitoring, automated insulin delivery, and remote care in adolescents with type 1 diabetes: advances toward integrated digital management

Type 1 diabetes management in adolescents remains challenging due to physiological and behavioral factors. This review summarizes recent advances in three interconnected technologies: continuous glucose monitoring (CGM), automated insulin delivery (AID), and remote care. CGM provides real-time glycemic data with time in range (TIR) as the core metric, improving glycemic outcomes when implemented with structured education. AID systems, particularly hybrid closed-loop devices, consistently increase TIR, reduce glycated hemoglobin (HbA1c), and lower risks of severe hypoglycemia and diabetic ketoacidosis (DKA) across randomized trials and real-world studies, with validated efficacy in children as young as 1-year-old. Remote care models leverage continuous data streams to enable individualized follow-up, showing glycemic outcomes approaching those of traditional visits in comparative studies while improving access and psychosocial support. Despite proven benefits, barriers remain, including socioeconomic inequities in technology access, alarm fatigue, and implementation gaps across healthcare systems. Future priorities include fully closed-loop systems, dual-hormone approaches, algorithm optimization for exercise and illness, long-term psychosocial outcomes, and equitable implementation strategies. Clinical practice should integrate these technologies through multidisciplinary teams, early initiation, and patient-centered support to transform adolescent diabetes care from intermittent visits to continuous digital management.