Original title: Complements or Substitutes? Technology Adoption and the Demand for Clinical Care: Evidence from Automated Insulin Delivery
Moslem Rashidi, Cristina Ugolini, Gianluca Fiorentini · September 2026
Do automated medical devices replace doctors, or do they make patients see doctors more often? Researchers wanted to know how this affects healthcare use. They tracked 1,608 adults with type 1 diabetes across four clinics in Italy, looking at those who started using automated insulin delivery. These devices track blood sugar and automatically deliver insulin to replace daily dosing choices. Instead of replacing doctors, the technology increased doctor visits. Patients were more likely to visit a specialist after adopting the system. Their need for clinical care grew over time as they required help interpreting data, making adjustments, and supervising the device. Tests and broader care measures also showed positive patterns. Overall, the technology takes over routine daily tasks, but it leads to more teamwork with doctors, reorganizing medical care instead of simply shrinking it.
You buy a rice cooker to free yourself from stirring and watching the pot. The routine part gets easier, but now you find yourself tasting earlier, checking the settings, and adjusting the recipe — dinner demands more attention, not less. In this paper, the rice cooker corresponds to automated insulin delivery, which takes over routine dosing decisions. The extra kitchen attention corresponds to the greater number of diabetes specialist visits that followed adoption.
For people with type 1 diabetes, a device that automates insulin dosing sounds like it should mean fewer clinic visits. This study finds the opposite: after adopting automated delivery, patients were more likely to see their diabetologist, with the gap growing over time. That matters for health systems deciding whether to fund such devices — the payoff may be better-organized care, not lower utilization.
The visit estimates are sensitive to the trend-extrapolation assumption, so they should be interpreted conditionally on that restriction. The effects on HbA1c testing and the broader process-of-care index are less precise, meaning those results are not as firmly established. Matching kept only 181 adopters out of 283, and the study is set in four specialist clinics of the Italian National Health Service, so the abstract does not establish whether findings extend to other settings or populations.
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Complements or Substitutes? Technology Adoption and the Demand for Clinical Care: Evidence from Automated Insulin Delivery — Moslem Rashidi, Cristina Ugolini, Gianluca Fiorentini
Abstract licence: CC0
Explanation generated by Synthesis from the abstract — it is not the original paper. This is a preprint, so it hasn't necessarily been peer reviewed.