Ethical Challenges in Automated Insulin Delivery and Emerging Diabetes Technologies

Recent technological advances have revolutionised the management of diabetes.Current innovative approaches incorporate continuous glucose monitoring (CGM), insulin pumps, and their coupling with an algorithm to create an automated insulin delivery system (AID), all integrated within a telemedicine framework.As we continue to integrate new technologies and artificial intelligence in diabetes care such as smart insulin pens, digital twin modelling and predictive tools, it is essential to study the dynamic changes in the patient-physician relationship, informed by our current experience with AID.The therapeutic alliance now encompasses a triadic interaction between healthcare providers, patients, and diabetes technologies (Figure 1).While technological innovations in diabetes management offer unprecedented therapeutic possibilities, they necessitate careful consideration of emerging ethical challenges within the scope of traditional bioethical principles of beneficence, non-maleficence, autonomy and justice.