Digital diabetes technology adoption and outcomes in Saudi children and adolescents with type 1 diabetes mellitus: A systematic review and meta-analysis

Saudi Arabia ranks among the top 10 countries globally for pediatric type 1 diabetes mellitus (T1DM) prevalence, with approximately 35,000 affected children and an annual incidence exceeding 31 per 100,000. Despite favorable regulatory conditions and Vision 2030 health transformation priorities, synthesized evidence on the outcomes of digital diabetes technology in Saudi pediatric populations remains limited. We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines (PROSPERO: CRD420251276422). PubMed, Scopus, Web of Science, and Google Scholar were searched for studies published between 2015 and −2025, examining continuous glucose monitoring, insulin pumps, hybrid closed-loop systems, and telemedicine in Saudi children aged 0–18 years with T1DM. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis compared insulin pump therapy versus multiple daily injections. Fifteen studies involving 3129 participants met inclusion criteria. Flash glucose monitoring demonstrated glycated hemoglobin (HbA1c) reductions of 1.7 percentage points over 9 months in 1307 children. Meta-analysis of insulin pump therapy ( n  = 519) showed a pooled mean difference of −1.53% (95% confidence interval [CI]: −2.35 to −0.71) favoring pumps over multiple daily injections, with substantial heterogeneity ( I ²  = 86%). Hybrid closed-loop systems enabled safe Ramadan fasting with time-in-range exceeding 71%. Telemedicine maintained glycemic control during the coronavirus disease 2019 (COVID-19) pandemic with caregiver satisfaction exceeding 66%. Sensitivity analysis restricted to strict pediatric populations (0–18 years, n  = 2173) confirmed findings. Digital diabetes technologies demonstrate consistent effectiveness in improving glycemic outcomes and quality of life among Saudi children with T1DM. However, significant implementation gaps persist due to cost barriers, restricted insurance coverage affecting over 70% of patients, and healthcare workforce shortages. Addressing these barriers through expanded reimbursement policies and specialized training programs is essential for realizing Vision 2030 health transformation goals.