Hybrid Closed-Loop Therapy in Adults with Type 1 Diabetes in England: Long-Term Outcomes from a Real-World Observational Study

<b><i>Objective:</i></b> To evaluate longitudinal real-world outcomes in adults with type 1 diabetes initiating hybrid closed loop (HCL). <b><i>Methods:</i></b> Adults with type 1 diabetes, managed with an insulin pump and intermittently scanned continuous glucose monitoring with hemoglobin A1c (HbA1c) ≥8.5% (69 mmol/mol), were started on HCL between August and December 2021 as part of the National Health Service England HCL pilot. We collected outcomes, including change in HbA1c, sensor glucometrics, Gold score (hypoglycemia awareness), diabetes distress score, acute event rates, and user opinion of HCL. <b><i>Results:</i></b> In total, 420 HCL users across 30 diabetes centers in the United Kingdom were included (median age 40 [interquartile range or IQR 29-50] years, 68% female, 85% White British). Over a median follow-up of 12 months (IQR 8-28) (range 6-38 months), mean adjusted HbA1c reduced by 1.4% (95% confidence interval [CI] -1.5, -1.3; <i>P</i> < 0.001) (16 mmol/mol [95% CI -17, -14]; <i>P</i> < 0.001). Time in range (70-180mg/dL) increased from 33.7% to 60.4% (<i>P</i> < 0.001). The proportion of individuals achieving HbA1c ≤7.5% (58 mmol/mol) increased from 0% to 33.1% (<i>P</i> < 0.001). Diabetes distress score reduced (-1.1; 95% CI -1.3, -1.0; <i>P</i> < 0.001) and Gold score reduced (-0.4; 95% CI -0.5, -0.2; <i>P</i> < 0.001). The percentage of individuals with impaired hypoglycemia awareness (Gold score ≥4) decreased (16.6% [baseline] vs. 9.2% [follow-up]; <i>P</i> < 0.001). Almost all participants stated that HCL had a positive impact on quality of life (94.5%; 361/382). The number of hospital admissions was low. <b><i>Conclusions:</i></b> 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.

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Journal
Diabetes Technology & Therapeutics
Published
2025-05-30
DOI
https://doi.org/10.1089/dia.2025.0165
Citations
1
Primary Topic
Diabetes Management and Research
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article
Field-Weighted Citation Impact
1.29
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article

Hybrid Closed-Loop Therapy in Adults with Type 1 Diabetes in England: Long-Term Outcomes from a Real-World Observational Study

Isy Douek, Emma G. Wilmot, Tomás P. Griffin, Sufyan Hussain et al.
1 citations
Diabetes Technology & Therapeutics
Diabetes Management and Research
1.29
article

Hybrid Closed-Loop Therapy in Adults with Type 1 Diabetes in England: Long-Term Outcomes from a Real-World Observational Study

Isy Douek, Emma G. Wilmot, Tomás P. Griffin, Sufyan Hussain, Ali Chakera, Hood Thabit, Simon Saunders, Clare Soar, Zin Zin Htike, Pratik Choudhary, Mindy Levitt, Zosanglura Bawlchhim, Mark L. Evans, Iain Cranston, Alexandros Leonidas Liarakos, Alistair N. Lumb, Robert E. J. Ryder, Thomas Crabtree, Parth Narendran, Jackie Elliott, Louise Curtis, Christopher Philbey, Lalantha Leelarathna, Geraldine Gallen, Alex Bickerton, Claire Williams, Lynn Sawyer, Jesina Kirby, Claire Wadham, Niall Furlong, Partha Kar, Philip J. Weston, Shafie Kamaruddin
article en
1 citations

Abstract

<b><i>Objective:</i></b> To evaluate longitudinal real-world outcomes in adults with type 1 diabetes initiating hybrid closed loop (HCL). <b><i>Methods:</i></b> Adults with type 1 diabetes, managed with an insulin pump and intermittently scanned continuous glucose monitoring with hemoglobin A1c (HbA1c) ≥8.5% (69 mmol/mol), were started on HCL between August and December 2021 as part of the National Health Service England HCL pilot. We collected outcomes, including change in HbA1c, sensor glucometrics, Gold score (hypoglycemia awareness), diabetes distress score, acute event rates, and user opinion of HCL. <b><i>Results:</i></b> In total, 420 HCL users across 30 diabetes centers in the United Kingdom were included (median age 40 [interquartile range or IQR 29-50] years, 68% female, 85% White British). Over a median follow-up of 12 months (IQR 8-28) (range 6-38 months), mean adjusted HbA1c reduced by 1.4% (95% confidence interval [CI] -1.5, -1.3; <i>P</i> < 0.001) (16 mmol/mol [95% CI -17, -14]; <i>P</i> < 0.001). Time in range (70-180mg/dL) increased from 33.7% to 60.4% (<i>P</i> < 0.001). The proportion of individuals achieving HbA1c ≤7.5% (58 mmol/mol) increased from 0% to 33.1% (<i>P</i> < 0.001). Diabetes distress score reduced (-1.1; 95% CI -1.3, -1.0; <i>P</i> < 0.001) and Gold score reduced (-0.4; 95% CI -0.5, -0.2; <i>P</i> < 0.001). The percentage of individuals with impaired hypoglycemia awareness (Gold score ≥4) decreased (16.6% [baseline] vs. 9.2% [follow-up]; <i>P</i> < 0.001). Almost all participants stated that HCL had a positive impact on quality of life (94.5%; 361/382). The number of hospital admissions was low. <b><i>Conclusions:</i></b> 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.

Diabetes Technology & TherapeuticsVol. 27(10)
Lancashire Teaching Hospitals NHS Foundation Trust (GB), North Bristol NHS Trust (GB), Nottingham University Hospitals NHS Trust (GB), University of Nottingham (GB), University of Liverpool (GB), University of Leicester (GB), King's College London (GB), Guy's and St Thomas' NHS Foundation Trust (GB), University of Cambridge (GB), Queen Elizabeth Hospital Birmingham (GB), Sandwell & West Birmingham Hospitals NHS Trust (GB), Royal Surrey County Hospital (GB), Princess Royal University Hospital (GB), County Durham and Darlington NHS Foundation Trust (GB), Royal Sussex County Hospital (GB), Worthing Hospital (GB), St Helens and Knowsley Teaching Hospitals NHS Trust (GB), Musgrove Park Hospital (GB), Northern General Hospital (GB), University Hospitals of Leicester NHS Trust (GB), Cambridge University Hospitals NHS Foundation Trust (GB), Harrogate and District NHS Foundation Trust (GB), Princess Royal Hospital (GB), Royal Liverpool University Hospital (GB), Nottingham City Hospital (GB), University of Manchester (GB), National Institute for Health and Care Research (GB), Portsmouth Hospitals NHS Trust (GB), Manchester University NHS Foundation Trust (GB), Thomas Foundation (AU), King's College Hospital NHS Foundation Trust (GB), Kings Health Partners (GB), King's College School (GB), Oxford Centre for Diabetes, Endocrinology and Metabolism (GB), Dorset County Hospital (GB), University Hospitals of Derby and Burton NHS Foundation Trust (GB), University Hospitals Sussex NHS Foundation Trust (GB), Yeovil District Hospital (GB), Ipswich Hospital (GB), Imperial College London (GB), Diabetes UK (GB), East Lancashire Hospitals NHS Trust (GB), University of Birmingham (GB), University of Sheffield (GB)
Openalex Percentile: Top 19%
Diabetes Management and Research
1.29
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