Hybrid Closed-Loop Therapy in Adults with Type 1 Diabetes in England: Long-Term Outcomes from a Real-World Observational Study
Authors' conclusion
Long-term real-world use of HCL is associated with sustained improvements in glycemic and person-reported outcomes in adults with type 1 diabetes and above-target HbA1c levels.
Study context
- Population
- Adults with T1D on insulin pump and isCGM with hemoglobin A1c (HbA1c) ≥8.5% (69 mmol/mol), started on hybrid closed loop (HCL) Aug–Dec 2021 in the NHS England HCL pilot, 30 UK diabetes centres; median age 40 years, 68% female, 85% White British
- Participants
- 420 adults30 diabetes centres
- Exposure
- HCL follow-up vs baseline
- HCLn = 420
- Outcome
- Change in mean adjusted HbA1c
- Follow-up
- Median 12 months (IQR 8-28) (range 6-38 months)
Methodological detailslongitudinal, multicentre
- Longitudinal
- Multicentre
Main finding
As reported in the abstract
Mean adjusted HbA1c reduction, %
1.4%
95% CI −1.5, −1.3P < 0.001
Mean adjusted HbA1c reduction, mmol/mol
16 mmol/mol
95% CI −17, −14P < 0.001
Observational data: associations, not effects.
Further findings
TIR (70-180mg/dL)
- TIR increased from 33.7% to 60.4% (P < 0.001)
Proportion achieving HbA1c ≤7.5% (58 mmol/mol)
- Proportion increased from 0% to 33.1% (P < 0.001)
Diabetes distress score
- Diabetes distress score reduced
- −1.1 (95% CI −1.3, −1.0; P < 0.001)
Gold score (hypoglycemia awareness)
- Gold score reduced
- −0.4 (95% CI −0.5, −0.2; P < 0.001)
Impaired hypoglycemia awareness (Gold score ≥4)
- Percentage decreased, baseline vs follow-up (P < 0.001)
- 16.6% vs. 9.2%
Positive impact of HCL on quality of life (user opinion)
- Participants stating HCL had a positive impact on quality of life
- 94.5%; 361/382
Hospital admissions
- The number of hospital admissions was low
Safety
- The number of hospital admissions was low
Original publication
Hybrid Closed-Loop Therapy in Adults with Type 1 Diabetes in England: Long-Term Outcomes from a Real-World Observational Study. Diabetes Technol Ther. Published 30 May 2025. doi:10.
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