American Diabetes Association
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Hybrid closed-loop therapy in adults with type 1 diabetes and above target HbA1c: a real-world observational study.

posted on 2023-08-11, 18:10 authored by Thomas S.J. Crabtree, Tomas P Griffin, Yew W. Yap, Parth Narendran, Gerladine Gallen, Niall Furlong, Iain Cranston, Ali J Chakera, Chris Philbey, Muhammad Ali Karamat, Sanjay Saraf, Shafie Kamaruddin, Eleanor Gurnell, Alyson Chapman, Sufyan Hussain, Jackie Elliott, Lalantha Leelarathna, Robert E.J. Ryder, Peter Hammond, Alistair Lumb, Pratik Choudhary, Emma G. Wilmot


We explored longitudinal changes associated with switching to hybrid closed loop (HCL) insulin delivery systems in adults with type 1 diabetes and elevated HbA1c levels despite the use of intermittently scanned continuous glucose monitoring (isCGM) and insulin pump therapy. 

Research Design and Methods

We undertook a pragmatic, pre-planned observational study of participants included in the NHS England closed-loop pilot. Adults using isCGM and insulin pump across 31 diabetes centers in England with a HbA1c ≥8.5%, who were willing to commence HCL therapy were included. Outcomes included change in HbA1c; sensor glucometrics; Diabetes Distress Score; Gold Score (hypoglycemia awareness); acute event rates and user opinion of HCL. 


In total, 570 HCL users were included; median age 40 (IQR 29-50) years, 67% female, and 85% White. Baseline HbA1c was 9.4±0.9% [78.9±9.1mmol/mol] with a median follow-up of 5.1 (IQR 3.9-6.6) months. Of 520 users continuing HCL at follow-up, mean adjusted HbA1c reduced by 1.7% (95% CI 1.5, 1.8, P<0.0001) [18.1mmol/mol; 95%CI 16.6, 19.6; P<0.0001]. Time in range (70-180mg/dL) increased from 34.2% to 61.9% (P<0.001). Individuals with HbA1c of ≤58mmol/mol rose from 0% to 39.4% (P<0.0001) and those achieving ≥70% glucose time in range and <4% time below range increased from 0.8% to 28.2% (P<0.0001). Almost all participants rated HCL therapy as having a positive impact on quality of life (94.7%, 540/570).


Use of HCL is associated with improvements in HbA1c, time in range, hypoglycemia and diabetes-related distress and quality of life in people with type 1 diabetes in the real-world. 


The Association of British Clinical Diabetologist’s Closed-Loop audit program is funded by the Diabetes Care Trust


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