Hybrid Closed-Loop Therapy in Adults With Type 1 Diabetes and Above-Target HbA1c: A Real-world Observational Study

In study (n=570, mean baseline HbA1c 9.4% in NHS closed loop [CL] pilot), hybrid CL was linked to improvements in HbA1c (-1.7%; p<0.0001), time in range (from 34.2 to 61.9%;p<0.001), hypoglycaemia, diabetes-related distress, and quality of life, at median follow-up of 5.1 months.

SPS commentary:

Hybrid closed-loop (HCL) insulin delivery systems combine insulin pump therapies with continuous glucose monitoring sensors to automate insulin delivery between meals and overnight to maintain glucose near a prespecified target level using algorithmic software contained within the insulin pump or a separate device (e.g., smartphone). The researchers note that currently available systems require a user-initiated meal bolus (a hybrid approach) and in U.K, the use of these systems has been limited by access to real-time CGM nationally and the need to meet criteria for insulin pump therapy as per NICE TA 151. They note that while updates to NICE guideline 17 (Type 1 diabetes in adults) may facilitate increased uptake of HCL through improved access to HCL-compatible real-time CGM, specific guidelines for UK use are not currently available.

Diabetes Care