Automated Insulin Delivery (AID) systems represent a significant advancement in diabetes care and wearable physiological closed-loop control technologies, integrating continuous glucose monitoring, control algorithms, and insulin pumps to improve blood glucose level control and reduce the burden of patient self-management. However, their increasing dependence on wireless communication and automatic control introduces security risks that may compromise patient privacy or result in life-threatening treatment errors. This paper presents a comprehensive survey of the AID system security landscape, covering technical vulnerabilities, regulatory frameworks, and commercial security measures. In addition, we conduct a systematic review of attack vectors and defence mechanisms proposed in the literature, following the PRISMA framework. Our findings highlight critical gaps, including the lack of specific security evaluation frameworks, insufficient protections in real-world deployments, and the need for comprehensive, lightweight, and adaptive defence mechanisms. We further investigate available research resources and outline open research challenges and future directions to guide the development of more secure and reliable AID systems. By focusing on AID systems, this review offers a representative case study for examining and improving the cybersecurity of safety-critical medical wearable systems.

翻译：自动化胰岛素输送（AID）系统代表了糖尿病护理和可穿戴生理闭环控制技术的重大进步，其通过整合连续血糖监测、控制算法和胰岛素泵，以改善血糖控制水平并减轻患者自我管理负担。然而，系统对无线通信和自动控制的日益依赖引入了可能危及患者隐私或导致危及生命的治疗错误的安全风险。本文对AID系统安全现状进行全面综述，涵盖技术漏洞、监管框架和商业安全措施。此外，我们遵循PRISMA框架，对文献中提出的攻击向量和防御机制进行了系统性回顾。我们的研究结果凸显了若干关键空白，包括缺乏专门的安全评估框架、实际部署中保护措施不足，以及对全面、轻量级且自适应防御机制的需求。我们进一步调研了现有研究资源，并概述了开放的研究挑战与未来方向，以指导开发更安全可靠的AID系统。通过聚焦AID系统，本综述为审视和提升安全关键型医疗可穿戴系统的网络安全提供了一个代表性案例研究。