Hybrid closed-loop therapy in ddults with type 1 Diabetes in England : long-term outcomes from a real-world observational study
Liarakos, Alexandros L Crabtree, Thomas S J Griffin, Tomás P Hussain, Sufyan Gallen, Geraldine Elliott, Jackie Furlong, Niall Narendran, Parth Thabit, Hood Leelarathna, Lalantha
Liarakos, Alexandros L
Crabtree, Thomas S J
Griffin, Tomás P
Hussain, Sufyan
Gallen, Geraldine
Elliott, Jackie
Furlong, Niall
Narendran, Parth
Thabit, Hood
Leelarathna, Lalantha
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Affiliation
University Hospitals of Derby and Burton NHS Foundation Trust; University of Nottingham; University Hospitals of Leicester NHS Foundation Trust; Sandwell and West Birmingham NHS Trust; et al.
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Publication date
2025-05-30
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Abstract
Objective: To evaluate longitudinal real-world outcomes in adults with type 1 diabetes initiating hybrid closed loop (HCL). Methods: 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. Results: 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; P < 0.001) (16 mmol/mol [95% CI -17, -14]; P < 0.001). Time in range (70-180mg/dL) increased from 33.7% to 60.4% (P < 0.001). The proportion of individuals achieving HbA1c ≤7.5% (58 mmol/mol) increased from 0% to 33.1% (P < 0.001). Diabetes distress score reduced (-1.1; 95% CI -1.3, -1.0; P < 0.001) and Gold score reduced (-0.4; 95% CI -0.5, -0.2; P < 0.001). The percentage of individuals with impaired hypoglycemia awareness (Gold score ≥4) decreased (16.6% [baseline] vs. 9.2% [follow-up]; P < 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. Conclusions: 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.
Citation
Liarakos AL, Crabtree TSJ, Griffin TP, Hussain S, Gallen G, Elliott J, Furlong N, Narendran P, Thabit H, Leelarathna L, Evans ML, Philbey C, Cranston I, Kamaruddin S, Htike ZZ, Sawyer L, Curtis L, Kirby J, Douek I, Chakera AJ, Saunders S, Bickerton A, Bawlchhim Z, Soar C, Wadham C, Williams C, Levitt M, Weston P, Kar P, Ryder REJ, Lumb A, Choudhary P, Wilmot EG. Hybrid Closed-Loop Therapy in Adults with Type 1 Diabetes in England: Long-Term Outcomes from a Real-World Observational Study. Diabetes Technol Ther. 2025 Oct;27(10):820-830. doi: 10.1089/dia.2025.0165. Epub 2025 May 30
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Journal Article