Leveraging the Internet of Medical Things (IoMT) in Diabetes Care: A Review of Smart Insulin Pen Innovations

Background: Diabetes mellitus is a chronic metabolic disorder requiring precise glucose regulation. The Internet of Medical Things (IoMT) and smart insulin pens enable connected, data-driven insulin therapy, linking devices and health care systems for personalized management. This review critically synthesizes clinical evidence on smart insulin pens within the IoMT framework, evaluating study quality, guideline positioning, and translational barriers. Aim: This study examines the role of IoMT, with a focus on smart insulin pens. This review compares smart insulin pens with conventional insulin delivery methods, evaluating their clinical effectiveness, impact on patient quality of life, and challenges related to cost, training, and integration into health care systems. Methods: A comprehensive review of literature was performed using PubMed, Cochrane, Web of Science, and Embase databases, focusing on randomized controlled trials (RCTs), clinical trials, registries, guidelines, and expert consensus documents related to smart insulin pens and IoMT in diabetes care. Two authors performed a structured risk-of-bias assessment (domains: study design, sample size, funding source, outcome definitions, follow-up duration, and generalizability) of key studies and extracted standardized endpoints (HbA1c, time-in-range, adherence metrics, and patient-reported outcomes). Results: Insulin pens have proven advantages in diabetes management. A 12-week study showed insulin pens reduced average glucose levels with higher patient satisfaction. Many studies showed that these devices make treatment more consistent and effective. Both patients and doctors preferred them. However, studies showed that they are unaffordable for low-income groups, and even physicians lack enough training for their use. Future trends should focus on making them more user-friendly. While numerous studies report positive outcomes, many are small, short-term, industry-sponsored, or observational. When considering independently conducted RCTs and high-quality registries, the observed benefits are more modest, and results show considerable variability. Conclusions: Smart insulin pens can be very helpful in the management of diabetes. They provide accurate dosage based on patient data and simplify patient care. However, due to privacy issues, high costs, and limited training of the health care professionals, their use is limited. Robust, long-term randomized trials and cost-effectiveness analyses across diverse health care settings are needed before broad guideline recommendations can be made.