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Hybrid Closed-Loop Therapy in Adults With Type 1 Diabetes and Above-Target HbA1c: A Real-world Observational Study
Thomas S J Crabtree1,2, Tomás P Griffin3,4, Yew W Yap5
1Department of Diabetes and Endocrinology, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Trusts, Derby, U.K.
Diabetes Care
|August 11, 2023
Summary
Switching to hybrid closed-loop (HCL) insulin systems significantly improved HbA1c and glucose control in adults with type 1 diabetes. This advanced therapy also enhanced quality of life and reduced diabetes distress in real-world use.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Medical Devices
Background:
- Type 1 diabetes management often involves insulin pump therapy and continuous glucose monitoring.
- Some individuals struggle to achieve optimal glycemic control (HbA1c ≥8.5%) even with existing technologies.
- Hybrid closed-loop (HCL) systems represent an advancement in automated insulin delivery.
Purpose of the Study:
- To evaluate the longitudinal effects of switching to HCL insulin delivery systems.
- To assess changes in glycemic control, diabetes distress, and quality of life in adults with type 1 diabetes.
- To investigate outcomes in individuals with elevated HbA1c despite using intermittently scanned continuous glucose monitoring (isCGM) and insulin pump therapy.
Main Methods:
- A pragmatic, preplanned observational study was conducted within the National Health Service England closed-loop pilot.
- Participants included adults with type 1 diabetes using isCGM and insulin pumps, with baseline HbA1c ≥8.5%, who initiated HCL therapy.
- Outcomes measured included changes in HbA1c, sensor glucometrics, diabetes distress, hypoglycemia awareness, acute events, and user satisfaction.
Main Results:
- Mean HbA1c decreased by 1.7% (P < 0.0001) in users continuing HCL therapy.
- Time in range (70-180 mg/dL) significantly increased from 34.2% to 61.9% (P < 0.001).
- A substantial proportion of users achieved target glycemic goals (HbA1c ≤58 mmol/mol and ≥70% time in range), with 94.7% reporting a positive impact on quality of life.
Conclusions:
- Hybrid closed-loop (HCL) insulin delivery systems demonstrate significant improvements in glycemic control (HbA1c, time in range) in adults with type 1 diabetes.
- HCL therapy is associated with reduced diabetes-related distress and enhanced quality of life in a real-world setting.
- These findings support the adoption of HCL systems for individuals with type 1 diabetes experiencing suboptimal control on conventional insulin pump and isCGM therapy.
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