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Review Article Volume 13 Issue 1
Drug-device combination products for precision medicine in diabetes and metabolic disorders: a review
Loso Judijanto
Received: June 01, 2026 | Published: June 17, 2026
Citation: Judijanto L. Drug-device combination products for precision medicine in diabetes and metabolic disorders: a review. J Diabetes Metab Disord Control. 2026;13(1):63-75. DOI: 10.15406/jdmdc.2026.13.00316
Abstract
Diabetes, obesity, and related metabolic disorders are increasing globally and require treatment models that can adapt to heterogeneous patient phenotypes, medication responses, self-management capacity, and access to technology. Drug-device combination products (DDCPs), including continuous glucose monitoring-linked insulin delivery, automated insulin delivery systems, smart insulin pens, insulin pumps, and incretin pen devices, are increasingly relevant because they integrate pharmacotherapy with delivery reliability, dose documentation, sensor data, software feedback, and patient behaviour. This PRISMA-based systematic literature review synthesises recent evidence on DDCPs and device-enabled pharmacotherapies for precision treatment in diabetes and metabolic disorders. PubMed/MEDLINE, Scopus, Web of Science, and ScienceDirect were searched for English-language peer-reviewed literature published from January 2020 to May 2026, supplemented by guideline, regulatory, and citation tracking. Eligible evidence addressed DDCPs or device-enabled treatment systems relevant to diabetes mellitus, obesity, metabolic syndrome, insulin resistance, glycemic control, adherence, safety, implementation, or equity. A final corpus of 87 studies was included in qualitative synthesis. Risk of bias was assessed using RoB 2 for randomised and crossover trials, ROBINS-I for non-randomised and observational studies, AMSTAR 2 for systematic reviews, and CASP/ JBI-oriented criteria for qualitative, implementation, and mixed-method evidence. Evidence most consistently supported continuous glucose monitoring-linked insulin delivery, smart insulin pens, insulin pumps, and automated insulin delivery systems for improving insulindose visibility, reducing missed or delayed boluses, increasing time in range, supporting individualised titration, and enabling more responsive clinical decision-making. Several key trials reported statistically significant benefits, including improved HbA1c and time in range with continuous glucose monitoring or closed-loop insulin delivery. Emerging evidence also indicates that connected pen devices for GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists may strengthen adherence and treatment persistence in obesity and cardiometabolic care, although long-term comparative data remain limited. Key barriers included regulatory complexity, interoperability gaps, cybersecurity and privacy risks, algorithmic bias, affordability, reimbursement uncertainty, unequal access, psychosocial burden, fear of device malfunction, stigma related to device visibility, troubleshooting burden, and dermatologic complications such as irritant or allergic contact dermatitis and insertion-site infection. Overall, DDCPs are clinically relevant precision-medicine tools for the control of diabetes and metabolic disorders. Broader implementation requires stronger real-world evidence, inclusive validation, harmonised regulatory pathways, equitable digital-health infrastructure, dermatologic safety monitoring, and patient-centred support for long-term device use.
Keywords: systematic literature review, PRISMA 2020, diabetes mellitus, metabolic disorders, continuous glucose monitoring, automated insulin delivery, smart insulin pens, drug-device combination products, obesity, GLP-1 receptor agonists, metabolic control
©2026 Judijanto. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.