Materiały źródłowe

• #1 Hybrid Closed-Loop Systems for the Treatment of Type 1 Diabetes: A Collaborative, Expert Group Position Statement for Clinical Use in Central and Eastern Europe

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8586062/

  In both pediatric and adult populations with type 1 diabetes (T1D), technologies such as continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), or sensor-augmented pumps (SAP) can consistently improve glycemic control while reducing the risk of hypoglycemia. […] Novel hybrid closed-loop (HCL) systems represent the latest treatment modality for T1D, combining modern glucose sensors and insulin pumps with a linked control algorithm to offer automated insulin delivery in response to blood glucose levels and trends. HCL systems have been associated with increased TIR, improved HbA1c, and fewer hypoglycemic events compared with CSII, SAP, and MDI, thereby potentially improving quality of life for people with diabetes (PwD) while reducing the costs of treating short- and long-term diabetes-related complications.

• #2 researchopenworld.com

  https://researchopenworld.com/hybrid-closed-loop-systems-for-the-treatment-of-type-1-diabetes-narrative-review/

  Hybrid Closed-Loop Systems (HCLS), or else Automated Insulin Delivery (AID) systems represent the most advanced currently available treatment for T1D. […] These systems integrate data from Continuous Glucose Monitoring (CGM), a control algorithm and an insulin pump into an automated glucose-responsive subcutaneous insulin infusion. […] Limited data from Randomized Controlled Trials and meta-analyses and growing evidence from real-world use support the superiority of Hybrid Closed-Loop Systems in improving all the Ambulatory Glucose Profile metrics compared to Sensor Augmented Pumps or Multiple Daily Injections with Continuous Glucose Monitoring. […] Commercially available Hybrid Closed-Loop Systems are effective in reducing HbA1c, increasing Time In Range and decreasing time in the hypoglycemic range in individuals with Type 1 diabetes.

• #3 Hybrid Closed-Loop Systems for the Treatment of Type 1 Diabetes: A Collaborative, Expert Group Position Statement for Clinical Use in Central and Eastern Europe

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8586062/

  Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) are two diabetes technologies that have revolutionized diabetes care, with both technologies associated with improved HbA1c levels, increased TIR, and fewer hypoglycemic events compared with MDI. […] CGM is achieved through a compact medical device that monitors blood glucose levels in real time, which can send alerts to either a dedicated monitoring device or a smartphone app. […] CSII is achieved through devices known as insulin pumps, which provide a readily available and steady administration of insulin subcutaneously, while also allowing the user to instantaneously administer insulin should the need arise to help control blood glucose levels. […] Novel hybrid closed-loop (HCL) systems represent advanced diabetes technology that provide automated insulin delivery driven by algorithms, which can respond automatically to changes in blood glucose levels and administer basal and correction bolus insulin doses appropriately. […] HCL systems have been associated with significantly fewer hypoglycemic events and improved TIR compared with typical pump therapy with or without LGS.

• #4 What are Automated Insulin Delivery Systems? | Medtronic

  https://www.medtronicdiabetes.com/treatments/automated-insulin-delivery

  Automated insulin delivery (AID) systems combine an insulin pump and continuous glucose monitor (CGM) to help people living with type 1 diabetes manage their blood sugar levels. […] AID systems, also known as hybrid closed loop systems, can detect changes in a persons sugar levels in real time and automatically adjust insulin doses in response. […] The CGM tracks your sugar levels every few minutes through a small sensor inserted under the skin. […] The algorithm uses current and past sugar level trends to anticipate, adjust, and correct insulin delivery. […] Its no surprise why the American Diabetes Association calls automated insulin delivery systems the standard of care for people with type 1 diabetes. […] The MiniMed 780G system is intended for continuous delivery of basal insulin at selectable rates, and the administration of insulin boluses at selectable amounts for the management of type 1 diabetes mellitus in persons seven years of age and older requiring insulin as well as for the continuous monitoring and trending of glucose levels in the fluid under the skin.

• #5 Closed loop systems | Diabetes tech | Diabetes UK

  https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/technology/closed-loop-systems

  Some people with type 1 diabetes use an insulin pump and a continuous glucose monitor that talk to each other. It does this through a computer programme on your phone or inside the pump. […] This is called a closed loop system. It is sometimes known as an artificial pancreas. It can do some of the work for you to help manage your blood sugar levels (apart from you tapping in the carbs from the food you eat). The doses of insulin your body needs through the day and night to help keep your blood sugar levels stable are released via your pump. Some of these are adjusted automatically in response to your blood sugar levels which are monitored all the time by the continuous glucose monitor (CGM). […] In November 2023, new hybrid closed-loop recommendations were published by the National Institute for Health and Care Excellence (NICE) which said that over the next five years hundreds of thousands of people living with type 1 diabetes in England and Wales should be offered this technology.

• #6 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?number=2703

  Future CGM systems There are potential options for the use of CGM in the management of diabetes in the near future. […] The effectiveness of rtCGM has been confirmed in various randomized controlled trials (RCTs) with different types of diabetes and insulin regimens. […] The glycemic outcome was different based on the glycemic status of the study population included. […] The use of rtCGM reduces HbA1c by about 0.3% to 0.6%. […] Today, structured education specifically for CGM has been recognized as an essential part of diabetes therapy. […] The CIP is a new technology with a function that displays the last dose of insulin and timing and has reminder alerts that integrate with a smart app. […] Currently, a few clinical trials are collecting data on the effectiveness of these CIPs.

• #7 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?doi=10.4093/dmj.2022.0271

  However, technological advances including continuous glucose monitoring (CGM), connected insulin pens (CIPs), insulin pumps, and automated insulin delivery (AID) algorithms combined with education have made it possible to achieve the optimal control of diabetes using insulin. […] The effectiveness of rtCGM has been confirmed in various randomized controlled trials (RCTs) with different types of diabetes and insulin regimens. […] The glycemic outcome was different based on the glycemic status of the study population included. […] The use of rtCGM reduces HbA1c by about 0.3% to 0.6%. […] The use of rtCGM without education limits better glycemic outcomes. […] Today, structured education specifically for CGM has been recognized as an essential part of diabetes therapy. […] The CIP is a new technology with a function that displays the last dose of insulin and timing and has reminder alerts that integrate with a smart app.

• #8 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?number=2703

  However, technological advances including continuous glucose monitoring (CGM), connected insulin pens (CIPs), insulin pumps, and automated insulin delivery (AID) algorithms combined with education have made it possible to achieve the optimal control of diabetes using insulin. […] The first CGM system was approved by the U.S. Food and Drug Administration (FDA) in 1999. […] With the steady improvement in sensor accuracy, duration of wear, and smaller size, the use of CGM is expanding widely. […] The Dexcom G6 specified for 10-day wear is the first interoperable device with an AID system. […] The Medtronic Guardian 3 sensor (Medtronic, Northridge, CA, USA) was approved by the FDA in February 2018. […] In May 2021, Medtronics developed the Guardian 4 sensor with the same 7-day duration of wear but requiring no calibrations.

• #9 Clinical Experience with the Hybrid Closed-Loop Insulin Delivery System (MinimedTM 670G) compared to Sensor Augmented Therapy (MiniMedTM 640G) and standard care

  https://symbiosisonlinepublishing.com/endocrinology-diabetes/endocrinology-diabetes132.php

  Clinical Experience with the Hybrid Closed-Loop Insulin Delivery System (MinimedTM 670G) compared to Sensor Augmented Therapy (MiniMedTM 640G) and standard care. […] This real-world clinical study compared the efficacy of a hybrid closed-loop system (HCL) to a sensor integrated pump (SIP) system and usual care. […] The advent of Continuous Glucose Monitoring (CGM) has opened a new paradigm for people with diabetes on insulin therapy. […] The use of CGM with Insulin pump therapy (CSII) is well established, but increasingly has been promoted for use with individuals on Multiple Insulin Injection Regimens (MIR). […] The efficacy of CGM in reducing hypoglycemia in individuals with severe hypoglycemia unawareness has recently been confirmed. […] This study compares the sequential effects of standard therapy versus the use of SIP using the MiniMedTM 640G and then HCL with the MiniMedTM 670G system in a group of subjects with type 1 diabetes.

• #10 Closing the loop with insulin pumps – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/closing-the-loop-with-insulin-pumps

  There is significant responsibility when living with diabetes. It affects all aspects of a person’s life and health. And monitoring and adjusting to blood sugar levels can feel like a never-ending task. […] A hybrid closed-loop insulin pump is a new tool to manage the disease and make life a bit easier for people living with diabetes. […] An insulin pump is a small, computerized device worn outside of the body that delivers insulin under the skin. A hybrid closed loop insulin pump attempts to mimic the body’s natural communication loop by linking with a secondary device called a continuous glucose monitor, or CGM, sensor and automatically adjusting some of the insulin delivered based on continually monitored blood sugar levels. […] Research has shown that hybrid closed loop insulin pumps provide many benefits for people living with diabetes, including: Reduced risk of low blood sugars Clinical trials have shown that hybrid closed loop insulin pumps reduce the risk of low blood sugar. […] Improved monitoring and response to trends All hybrid closed loop insulin pumps will monitor blood sugar trends over time. […] Hybrid closed loop insulin pumps are exciting new tools that can significantly improve into the health and wellness of people living with diabetes.

• #11 Continuous glucose monitoring and hybrid closed loop for diabetes – NHS

  https://www.nhs.uk/conditions/cgm-and-hcl-for-diabetes/

  Continuous glucose monitors and hybrid closed loop systems are technology that can help people with diabetes manage their blood glucose (sugar) levels. […] A continuous glucose monitor (CGM) is a device for people with diabetes that lets you check your glucose (sugar) levels at any time. […] It can help you control your blood glucose levels, as you’ll have more information and can take action quickly. […] A hybrid closed loop system (sometimes called an „artificial pancreas”) is technology that allows a CGM to work together with an insulin pump to help you manage your blood glucose. […] A hybrid closed loop system can improve your blood glucose levels, reduce the risk of hypos and make it easier to manage diabetes. […] Hybrid closed loop systems are being made available on the NHS to some people with type 1 diabetes.

• #12 At a glance factsheet: Hybrid closed-loop therapy – DiabetesontheNet

  https://diabetesonthenet.com/diabetes-primary-care/factsheet-hybrid-closed-loop-therapy/

  In December 2023, NICE published the TA943 guidance, which lays out recommendations for use of hybrid closed-loop (HCL) systems in the management of type 1 diabetes, with a 5-year roll-out plan. […] An HCL system, also known as an artificial pancreas or Automated Insulin Delivery (AID) system, refers to the use of an insulin pump that is looped with an algorithm that continuously takes data from a continuous glucose monitoring (CGM) device to make and communicate decisions on insulin dosing to maintain glucose levels within the target range. […] The CGM device measures interstitial glucose every 15 minutes and transmits data by Bluetooth to the insulin management algorithm on either the pump or the smartphone. […] There is high-quality evidence that HCL technology results in better glycaemic control than insulin pump or sensor-augmented pump therapy, achieving more time in target glycaemic range, less time in hyper- and hypoglycaemia, less severe hypoglycaemia and improved HbA1c.

• #13 Hybrid Closed-Loop Systems for the Treatment of Type 1 Diabetes: A Collaborative, Expert Group Position Statement for Clinical Use in Central and Eastern Europe

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8586062/

  Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) are two diabetes technologies that have revolutionized diabetes care, with both technologies associated with improved HbA1c levels, increased TIR, and fewer hypoglycemic events compared with MDI. […] CGM is achieved through a compact medical device that monitors blood glucose levels in real time, which can send alerts to either a dedicated monitoring device or a smartphone app. […] CSII is achieved through devices known as insulin pumps, which provide a readily available and steady administration of insulin subcutaneously, while also allowing the user to instantaneously administer insulin should the need arise to help control blood glucose levels. […] Novel hybrid closed-loop (HCL) systems represent advanced diabetes technology that provide automated insulin delivery driven by algorithms, which can respond automatically to changes in blood glucose levels and administer basal and correction bolus insulin doses appropriately. […] HCL systems have been associated with significantly fewer hypoglycemic events and improved TIR compared with typical pump therapy with or without LGS.

• #14 Hybrid closed loop technology (artificial pancreas) | Breakthrough T1D UK

  https://breakthrought1d.org.uk/knowledge-support/managing-type-1-diabetes/guide-to-type-1-diabetes-technology/hybrid-closed-loop-technology-artificial-pancreas/

  Hybrid closed loop technology also known as the artificial pancreas automates many of the decisions that you have to make on a daily basis when you have type 1 diabetes. […] A hybrid closed loop system takes readings from a continuous glucose monitor and uses an algorithm to tell an insulin pump how much insulin to deliver. It does this 24 hours a day. […] If youre using a hybrid closed loop system, you use a CGM instead of a blood glucose meter, an insulin pump instead of a pen, and an algorithm instead of your brain. […] The CGM tells the algorithm what your glucose levels are and the algorithm tells the pump how much insulin to deliver. […] By automating the treatment loop, hybrid closed loop systems can dramatically reduce the number of decisions you have to make every day. […] With hybrid closed loop systems, you can spend more time with your glucose levels in range, with less effort.

• #15 Combining continuous glucose monitoring and insulin pumps to automatically tune the basal insulin infusion in diabetes therapy: a review | BioMedical Engineering OnLine | Full Text

  https://biomedical-engineering-online.biomedcentral.com/articles/10.1186/s12938-019-0658-x

  For individuals affected by Type 1 diabetes (T1D), a chronic disease in which the pancreas does not produce any insulin, maintaining the blood glucose (BG) concentration as much as possible within the safety range (70-180 mg/dl) allows avoiding short- and long-term complications. Continuous glucose monitoring (CGM) sensors, which monitor glucose concentration in the subcutaneous tissue almost continuously, allowed improving the detection of critical hypo- and hyper-glycemic episodes. Moreover, their integration with insulin pumps for continuous subcutaneous insulin infusion allowed developing algorithms that automatically tune insulin dosing based on CGM measurements in order to mitigate the incidence of critical episodes. […] Approaches to automatically tune insulin dosing based on CGM measurements have been an intense area of research in the last 10 years. As first step towards the development of a fully closed-loop system, also called artificial pancreas, academic research groups and companies investigated algorithms to automatically attenuate or suspend basal insulin infusion based on CGM measurements, e.g. when CGM detects hypoglycemia or CGM trend reveals a risk for imminent hypoglycemia.

• #16 Technology & Innovation – Hybrid Closed Loop Systems – DigiBete

  https://www.digibete.org/technology-innovation-hybrid-closed-loop-systems/

  A hybrid closed-loop system allows a person living with type 1 to wear an insulin pump that integrates or talks to a continuous glucose monitor (CGM). The system continuously monitors glucose levels and calculates the amount of insulin required. It then automatically adjusts the background, or basal insulin, based on a persons glucose readings. Hybrid Closed Loop pumps can stop basal insulin if it predicts the person is going low or can correct high glucose levels by adjusting the basal insulin and giving a correction dose of insulin. […] When wearing a hybrid closed loop system, you will still need to enter the grams of carbohydrate you are eating into the pump, before a meal, so that a correct calculation can be made by the pump. You will also need to tell the pump if you are going to exercise so this is taken into account and adjustments to insulin are made.

• #17 Advanced Technology (Continuous Glucose Monitoring and Advanced Hybrid Closed-Loop Systems) in Diabetes from the Perspective of Gender Differences

  https://www.mdpi.com/2673-4540/4/4/45

  An ever-growing body of evidence suggests that sex and gender influence the pathophysiology, incidence, prevalence, clinical manifestations, course, and response to therapy of diabetes. […] The turning point came in 2000 with the introduction of continuous glucose monitoring (CGM) and the first miniaturised insulin pumps (CSII) equipped with advanced functions; from the integration of the two devices, it was possible to create the SAP (Sensor Augmented Pump) system; from this moment on, the development of technologies has undergone an acceleration, up to the creation and appearance on the market of the first artificial pancreas system (Automatic Insulin Delivery—AID), closed-loop, and hybrid systems (HCL—Hybrid Closed Loop) a century after the discovery of insulin. […] HCL, by regulating the delivery of basal insulin for 24 h, in addition to preventing hypoglycaemia, also allows the better management of hyperglycaemia; this aspect is perfected with advanced hybrid closed-loop systems (AHCL), which are able to automatically deliver the correction boluses as well, and, therefore, allow reducing the time spent in hypoglycemia (TBR) and hyperglycaemia (TAR), with an improvement of the time in range (TIR).

• #18 researchopenworld.com

  https://researchopenworld.com/hybrid-closed-loop-systems-for-the-treatment-of-type-1-diabetes-narrative-review/

  The efficacy and safety of HCLS have been tested in a limited number of RCTs. […] Overall, the existing meta-analyses comprising data from a wide range of patients and interventions in outpatient settings have shown the superiority of HCLS over conventional treatments in increasing time in euglycemia and reducing time in hypoglycemia in individuals with T1D. […] Commercially available HCLS are effective in reducing HbA1c, increasing TIR and decreasing time spent in hypoglycemia in individuals with T1D.

• #19 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy

  https://health.learning.wiley.com/courses/dom-15999/

  Continuous glucose monitoring (CGM) has led to a paradigm shift in the management of pregnant women with type 1 diabetes (T1D), with improved glycaemic control, less hypoglycaemia and fewer pregnancy complications. […] In addition to CGM, other technologies, such as advanced hybrid closed-loop (AHCL) systems have further improved glycaemic management in people with T1D. AHCL therapy adapts insulin delivery via a predictive algorithm integrated with CGM and an insulin pump. A large RCT with the AHCL CamAPS FX demonstrated a 10% increase in time in range compared to standard insulin therapy in a pregnant population with T1D. […] Recently, an RCT of an AHCL system not approved for use in pregnancy (780G MiniMed) has also demonstrated additional benefits of AHCL therapy compared to standard insulin therapy, with improved time in range overnight, less hypoglycaemia and improved treatment satisfaction. More evidence is needed on the impact of AHCL therapy on maternal and neonatal outcomes and on which glycaemic targets with CGM should be used in pregnant women with T2D and GDM. We review the current evidence on the use of CGM and AHCL therapy in pregnancy.

• #20 Study: Hybrid Closed-Loop Insulin Therapy Improves Glycemic Control in Type 1 Diabetes

  https://www.pharmacytimes.com/view/study-hybrid-closed-loop-insulin-therapy-improves-glycemic-control-in-type-1-diabetes

  Research shows that closed-loop systems can increase time in range and reduce both hyperglycemia and hypoglycemia in youth and young adults. […] New research has found that a hybrid closed-loop insulin therapy improved glycemic control in adolescents and young adults with type 1 diabetes, according to an article published in Diabetes Technology Therapeutics (DTT). […] Closed-loop insulin delivery may help improve glycemic control, although outcomes data are scarce in pediatric and young adult populations. […] Short-term studies in monitored clinical settings and at diabetes camps have found that closed-loop systems can increase time in range (TIR) and reduce both hyperglycemia and hypoglycemia. […] According to the findings, the TIR for glycemic control increased by 13% for the CLC group compared to a decrease of 1% in the SAP group.

• #21 YpsoPump with mylife Loop – mylife Diabetescare – International

  https://www.mylife-diabetescare.com/en/mylife-loop.html

  The learning takes place on three levels: Overall learning, Diurnal learning (over 24 hours), and Post-meal learning. […] The use of CamAPS FX in young children aged 1 to 7 years documented clinically and statistically significant reduction of HbA1c by 0.4%, and an increase in time in target glucose range by 9% without increasing time in hypoglycaemia below 3.9 mmol/L (70 mg/dL). […] The use of the CamAPS FX control algorithm in people aged 6 years and older including adults resulted in reduction of HbA1c by 0.4%, increased time in target glucose range by 11%, and reduced time in hypoglycaemia below 3.9 mmol/L (70 mg/dL) by 0.8%. […] Control and monitoring of glucose, especially overnight, is a relief and leads to a better nights sleep. […] Thanks to its unique technology and highly adaptive capabilities, CamAPS FX demonstrated in the AiDAPT (Automated Insulin Delivery in Women with Pregnancy Complicated by Type 1 Diabetes) study that it can support women achieving their treatment goals during pregnancy, providing 10.5 % additional time in the pregnancy specific range, over the entire pregnancy period, without increasing hypoglycaemias.

• #22 Hybrid Closed-Loop Therapy Improves Diabetes Outcomes, Study Reveals

  https://www.drugtopics.com/view/hybrid-closed-loop-therapy-improves-diabetes-outcomes-study-reveals

  Automation in closed-loop systems improves type 1 diabetes outcomes and glucose profiles in teens, according to a study published in JAMA Pediatrics. […] Six months of hybrid closed-loop therapy can significantly improve both glycemic control and quality of life in pediatric patients with type 1 diabetes (T1D), according to research results published in JAMA Pediatrics. […] Hybrid closed-loop therapy also reduced the time that patients spent in a hypoglycemic range (difference, 1.9%; 95% CI, 2.5% to 1.3%) and improved glycemic variability (5.7%; 95% CI, 10.2% to 0.9%). Hybrid closed-loop therapy was associated with improved quality of life for patients with diabetes. […] To our knowledge, this is the first randomized controlled trial in youth with T1D to provide conclusive evidence that hybrid closed-loop improves glycemic outcomes and quality of life, they concluded. The hybrid closed-loop system represents an important step in the pursuit of technological advancements towards a fully automated closed loop system.

• #23 Advanced Hybrid Closed-Loop Technology Could Improve Quality of Life in Type 1 Diabetes

  https://www.drugtopics.com/view/advanced-hybrid-closed-loop-technology-could-improve-quality-of-life-in-type-1-diabetes

  The current study was designed by a team of investigators from institutions in Poland led by Katarzyna Cyranka, PhD, MA, of the University Hospital in Krakow, as a 9-month observational continuation of a 3-month randomized controlled trial, with the aim of exploring the effect of 1-year of use of an advanced hybrid closed-loop system on quality of life, level of anxiety, and self-efficacy. […] A total of 37 patients completed the study. At 3 months, time in range increased from 69.3% (SD, 12.3) at baseline to 85.0% (SD, 6.3) at 3 months in the advanced hybrid group, while remaining unchanged in the control group (treatment effect 21.5% [95% CI 15.727.3]; P 0.001). […] The primary outcomes of interest for the trial were change in quality of life, level of anxiety, and level of self-efficacy.

• #24 Study Explores Effect of Hybrid Closed-Loop Therapy on Diabetic Complications

  https://www.endocrinologyadvisor.com/news/study-explores-effect-of-hybrid-closed-loop-therapy-on-diabetic-complications/

  Hybrid closed-loop insulin delivery does not affect rate of severe hypoglycemia and increases rate of ketoacidosis. […] For young people with type 1 diabetes, hybrid closed-loop insulin delivery does not affect the rate of severe hypoglycemia and is associated with an increased risk for diabetic ketoacidosis, but it is also associated with a lower risk for hypoglycemic coma, according to a study published online in the February issue of The Lancet Diabetes Endocrinology. […] The researchers found that the rate of ketoacidosis was higher for those using closed- versus open-loop therapy (1.74 versus 0.96 per 100 patient-years; incidence rate ratio, 1.81), while there was no significant between-group difference in the rate of severe hypoglycemia. […] The rate of hypoglycemic coma was significantly lower for individuals using closed- versus open-loop therapy (0.62 versus 0.91 per 100 patient-years; incidence rate ratio, 0.68).

• #25 Type 1 Diabetes: Hybrid Closed-Loop and Open-Loop…

  https://www.dzd-ev.de/en/press/press-releases/press-releases-2025/type-1-diabetes-hybrid-closed-loop-and-open-loop-systems/index.html

  People with type 1 diabetes require continuous insulin treatment and must regularly measure their glucose levels. […] A study with the involvement of the German Center for Diabetes Research showed that hybrid closed-loop systems offer improved long-term blood sugar values (HbA1c levels) and a lower risk of hypoglycemic coma, but lead to a higher rate of diabetic ketoacidosis. […] The researchers investigated whether and how the rates of severe hypoglycemia and diabetic ketoacidosis differed between hybrid closed-loop insulin therapy and sensor-augmented (open-loop) pump therapy in young people with type 1 diabetes. […] The results: People using hybrid closed-loop therapy had a significantly lower rate of rate of hypoglycemic coma (0.62 per 100 patient-years) than those using open-loop therapy (0.91 per 100 patient-years).

• #26 Efficacy and safety of closed-loop control system for type one diabetes in adolescents a meta analysis | Scientific Reports

  https://www.nature.com/articles/s41598-023-40423-y

  This paved way for the artificial pancreas or called as the closed-loop system for diabetes management. […] Studies on inpatient and outpatient adolescent patients with T1DM have been done on closed-loop systems with improved glycemic outcomes and reduction in hypoglycemia in children, especially in the overnight period. […] This study is the first meta-analysis to examine the day and night time efficacy and safety monitoring comparison of CLC insulin delivery systems versus SAP therapy in the treatment of adolescents with T1DM. […] The results from this study shows the supreme authority of the CLC insulin delivery systems in maintaining all the glycemic outcomes than SAP therapy for day and night values of mean BG, TIR, and SD of glucose variability. […] The safety comparison results from this studies identifies that, CLC insulin delivery was associated with fewer AEs, especially hypoglycemic and hyperglycemic-related events during day and night, than SAP which deems CLC to be an ideal treatment of choice for adolescents with type 1 diabetes.

• #27 Hybrid Closed-Loop System Favorable for Type 1 Diabetes

  https://www.pharmacytimes.com/view/hybrid-closedloop-system-favorable-for-type-1-diabetes

  Closed-loop systems help diabetes patients achieve blood glucose control, according to a presentation at the American Diabetes Associations 77th Scientific Sessions. Continuous glucose monitoring (CGM) devices provide real-time data about blood glucose levels and even provide alerts when levels become too high or too low, while insulin pumps administer the treatment throughout the day. Recently, technology has combined CGM and insulin pumps to created closed-loop systems. These systems allow patients to receive insulin throughout the day from insulin pumps based on glucose measurements from the CGM system. […] Hybrid closed-loop systems do a great job improving glucose control overnight, significantly lowering the risk of hypoglycemia, thus allowing patients and their families to get a good nights sleep, said chief investigator Bruce A. Buckingham, MD. These systems also assist patients during the day in decreasing the magnitude of both high- and low-glucose fluctuations.

• #28 Study Explores Effect of Hybrid Closed-Loop Therapy on Diabetic Complications

  https://www.endocrinologyadvisor.com/news/study-explores-effect-of-hybrid-closed-loop-therapy-on-diabetic-complications/

  Hybrid closed-loop insulin delivery does not affect rate of severe hypoglycemia and increases rate of ketoacidosis. […] For young people with type 1 diabetes, hybrid closed-loop insulin delivery does not affect the rate of severe hypoglycemia and is associated with an increased risk for diabetic ketoacidosis, but it is also associated with a lower risk for hypoglycemic coma, according to a study published online in the February issue of The Lancet Diabetes Endocrinology. […] The researchers found that the rate of ketoacidosis was higher for those using closed- versus open-loop therapy (1.74 versus 0.96 per 100 patient-years; incidence rate ratio, 1.81), while there was no significant between-group difference in the rate of severe hypoglycemia. […] The rate of hypoglycemic coma was significantly lower for individuals using closed- versus open-loop therapy (0.62 versus 0.91 per 100 patient-years; incidence rate ratio, 0.68).

• #29 Type 1 Diabetes: Hybrid Closed-Loop and Open-Loop…

  https://www.dzd-ev.de/en/press/press-releases/press-releases-2025/type-1-diabetes-hybrid-closed-loop-and-open-loop-systems/index.html

  However, individuals using a hybrid closed-loop system had a higher rate of ketoacidosis (1.74 events per 100 patient-years) than those using open-loop therapy (0.96 per 100 patient-years). […] Due to the higher risk of ketoacidosis, it is important to provide patients with targeted information and, in case of potential metabolic decompensation, to closely monitor ketone bodies in the blood or urine in order to prevent such adverse events, emphasize the authors of the study. […] Hybrid closed-loop systems (HCL) are technologies used to treat type 1 diabetes. They combine an insulin pump, continuous glucose monitoring, and an algorithm for automated insulin delivery. […] Open-loop systems combine an insulin pump and continuous glucose monitoring (CGM). Unlike closed-loop systems, which automatically adapt insulin delivery, an open-loop system requires the user to make manual adjustments to insulin administration.

• #30 Six months of hybrid closed-loop therapy improves diabetes-specific positive well-being, and reduces diabetes distress and fear of hypoglycemia: secondary analysis of a randomized controlled trial | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/12/6/e004428

  In this multicenter, open-label, randomized, controlled, parallel-group clinical trial, adults with T1D were allocated to 26 weeks of HCL (MiniMed 670G) or standard therapy (insulin pump or multiple daily injections without real-time continuous glucose monitoring). […] At 13 weeks, the HCL group had better diabetes-specific positive well-being than the standard therapy group […] At 26 weeks, the HCL group also had less diabetes distress, fear of hypoglycemia, and perceived unacceptably high glucose levels. […] These findings imply that HCL offers important psychological benefits. […] The findings support that HCL can offer important psychological benefits over standard therapy to adults with T1D. Specifically, HCL led to higher diabetes-specific positive well-being, and lower diabetes distress, fear of hypoglycemia, and perceived frequency of unacceptably high glucose levels.

• #31 Can hybrid closed-loop systems improve well-being for adults with type 1 diabetes? – ACBRD

  https://acbrd.org.au/2025/03/27/can-hybrid-closed-loop-systems-improve-well-being-for-adults-with-type-1-diabetes/

  Hybrid closed-loop is medical device which helps people to manage their type 1 diabetes. It combines an insulin pump and continuous glucose monitor. It measures the wearers glucose levels and adjusts the amount of insulin they receive accordingly. […] Hybrid closed-loop helps people keep their glucose levels in range. And they alert the person, via an alarm, if their glucose levels get too high or low. This helps to keep them safe. […] Our research aimed to find out how hybrid closed-loop affects peoples psychological health and well-being. […] The people who took part filled-in psychological surveys at the start, middle (3-month follow-up) and end (6-month follow-up) of the study. […] By the end of the six months, people who used hybrid closed-loop had: Higher diabetes positive well-being. E.g. They felt more positive about diabetes and able to cope better with diabetes challenges. Lower diabetes distress. E.g. Diabetes felt like less of a problem, emotionally. Lower fear of hypos. E.g. They were less worried about having a hypo. […] This study helps us to better understand how diabetes technology affects peoples psychological health. The results show hybrid closed-loop can support improved well-being.

• #32 Six months of hybrid closed-loop therapy improves diabetes-specific positive well-being, and reduces diabetes distress and fear of hypoglycemia: secondary analysis of a randomized controlled trial | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/12/6/e004428

  In this 26-week, open-label, RCT of HCL versus standard therapy (CSII or MDI without real-time CGM), those allocated to HCL reported significantly greater diabetes-specific positive well-being at 13-week follow-up, which was maintained at 26 weeks. […] Adjusted analyses also showed reduced diabetes distress and fear of hypoglycemia (maintain high and worry subscales) favoring HCL. […] These novel findings demonstrate that HCL offers important psychological benefits over standard therapy to adults with T1D.

• #33 Managing Diabetes

  https://www.tandemdiabetes.com/support/diabetes-education/managing-diabetes/closed-loop-insulin-pump

  In my mind, the biggest benefit of using hybrid closed-loop technology has been improved sleep, said Dr. Pinsker. […] Control-IQ advanced hybrid closed-loop technology is a powerful predictive algorithm available on the t:slim X2 insulin pump from Tandem Diabetes Care. […] Control-IQ technology is intended for the management of Type 1 diabetes mellitus in persons six years of age and greater.

• #34 Diabetes hybrid closed loop systems | HFMA

  https://www.hfma.org.uk/publications/diabetes-hybrid-closed-loop-systems-0

  By 2024, NHS England noted the success of the programme for CGM in pregnancy: The NHS diabetes programme has exceeded expectations with over 75% of the type 1 diabetes population accessing flash glucose monitoring and 98% of eligible pregnant women having been offered CGM and 78% having accepted. […] Significant numbers of patients have proven that they can manage the technical inputs appropriately, even if they take time, require confidence and headspace to make the calculations. […] Hybrid closed loop (HCL) technology enables CGM and insulin pumps to talk to each other, automating the basic glucose testing and insulin injection process, even at night preventing the need for most sleep disrupting alarms. […] Benefits of using HCL (over separate CGM and insulin pumps) include improved management of glucose levels, reduced complications in pregnancy and as a result, reduction in neonatal intensive care unit admissions, greater headspace less need to constantly be calculating, less anxiety and mental load, fewer (or no) injections and fewer finger prick tests leading to a more flexible lifestyle, confidence that there will be fewer hyperglycaemic or hypoglycaemic events, and a reduction in the risk of future events and escalation of long-term conditions.

• #35

  https://www.healio.com/news/endocrinology/20220808/hybrid-closedloop-therapy-offers-greater-independence-for-young-people-with-diabetes

  Use of a hybrid closed-loop insulin delivery system provided greater independence and flexibility with glycemic management for young people with type 1 diabetes, according to study findings published in Diabetic Medicine. […] The study demonstrated an overall positive experience with improved glycemic control, less anxiety and independence with diabetes management. […] Adolescents and young adults with type 1 diabetes stated hybrid closed-loop therapy provided more independence with diabetes management while also reducing anxiety. […] Participants said they had more confidence because they were able to visualize glucose levels with the device. […] Most participants said they felt that the system gave them more independence over their diabetes management with less reliance on their parent.

• #36 Hybrid Closed Loop Therapy – Advanced Therapeutics (UK) Ltd

  https://www.advancedtherapeutics.org.uk/hybrid-closed-loop-therapy/

  One of the most significant advantages of the Hybrid Closed Loop Therapy System lies in its automation. Unlike traditional Type 1 diabetes management methods, where individuals manually calculate and administer insulin doses, this system takes on the task with minimal intervention. The artificial pancreas algorithms constantly analyse glucose data, ensuring that insulin delivery aligns seamlessly with the body’s needs. This not only reduces the cognitive load on individuals but also leads to more stable and predictable glucose levels. […] For those living with Type 1 diabetes, Hybrid Closed Loop Therapy can be a game-changer. It provides a level of freedom and confidence that was once unimaginable. No longer bound by the constant worry of fluctuating glucose levels, individuals can engage in daily activities, exercise and even enjoy meals with a newfound sense of ease.

• #37 In Brief: Hybrid Closed-Loop Systems for Type 1 Diabetes | CDA-AMC

  https://www.cda-amc.ca/brief-hybrid-closed-loop-systems-type-1-diabetes

  For people with type 1 diabetes and their caregivers, HCL systems may decrease the amount of time and energy spent on diabetes management and enable users to be more immersed in other aspects of their lives. […] The ethics analysis in the health technology assessment review highlighted the non-clinical and short-term clinical benefits of these systems but noted the uncertainty of whether the overall health of people with type 1 diabetes might improve over the long term.

• #38

  https://www.healio.com/news/endocrinology/20220808/hybrid-closedloop-therapy-offers-greater-independence-for-young-people-with-diabetes

  Use of a hybrid closed-loop insulin delivery system provided greater independence and flexibility with glycemic management for young people with type 1 diabetes, according to study findings published in Diabetic Medicine. […] The study demonstrated an overall positive experience with improved glycemic control, less anxiety and independence with diabetes management. […] Adolescents and young adults with type 1 diabetes stated hybrid closed-loop therapy provided more independence with diabetes management while also reducing anxiety. […] Participants said they had more confidence because they were able to visualize glucose levels with the device. […] Most participants said they felt that the system gave them more independence over their diabetes management with less reliance on their parent.

• #39 Which Hybrid Closed Loop Therapy System Is Right For Me? – Integrated Diabetes Services

  https://integrateddiabetes.com/which-hybrid-closed-loop-therapy-system-is-right-for-me/

  Hybrid closed loop therapy (HCL) is an incredible new tool for diabetes management. We can improve time in range and dramatically reduce hypoglycemia. […] A misstep can lead to a burden, being turned off to technology, and most importantly greatly increase the risk of diabetes burnout. […] HCL algorithms fall into three categories: Algorithms based on Total Daily Dose of insulin – (Omnipod 5 and Medtronic auto mode) These systems offer simplicity of use and the Omnipod system has no tubing. […] Algorithms based on user’s programmed basal rates and sensitivity – (Tandem Control IQ) These algorithms allow the user to change, more dynamically, how aggressive the system is by setting multiple profiles with differing basal rates, carb ratios, and correction factors that can change how aggressive the system responds.

• #40 Hybrid Closed Loop (HCL), explained. | Omnipod UK

  https://www.omnipod.com/en-gb/diabetes-hub/pod-uni/hybrid-closed-loop

  An AID system can help lessen the burden of managing your diabetes, as well as helping to reduce highs and lows throughout the day and night. […] AID stands for Automated Insulin Delivery and refers to a system that is able to automatically adjust insulin delivery based on glucose readings from an integrated continuous glucose monitor. […] Within this there are Hybrid Closed Loop systems (HCL). These automatically adjust basal insulin based on glucose readings from an integrated glucose monitor, with the user manually delivering bolus insulin to cover meals. […] The Omnipod 5 System is a wearable, on-body, tubeless, automated delivery (AID) system, also known as a hybrid closed loop system. […] Omnipod 5 works with compatible sensors to continuously adapt and automatically deliver insulin according to your personal needs.

• #41 Treatment for type 1 diabetes – NHS

  https://www.nhs.uk/conditions/type-1-diabetes/treatment/

  Some types of insulin pump work with a continuous glucose monitor to automatically give you the right amount of insulin based on your blood glucose levels. This is called a hybrid closed loop system. […] A hybrid closed loop system can reduce hypos, improve your blood glucose levels and reduce the burden of managing diabetes. […] Hybrid closed loop systems are gradually being made available on the NHS.

• #42 Advanced Hybrid Closed Loop | Medtronic HCP

  https://hcp.medtronic-diabetes.com.au/advanced-hybrid-closed-loop

  Hybrid closed loop systems use control algorithms to automate basal insulin delivery, based on glucose sensor values. Studies have demonstrated that hybrid closed loop systems improve HbA1c and time in range in people with T1D, while reducing hypoglycaemia and lowering HbA1c, compared to gold-standard insulin therapy. […] Advanced hybrid closed loop systems, such as the MiniMed 780G, with SmartGuard technology, automatically adjusts basal insulin delivery every five minutes, based on CGM readings. This cutting-edge technology helps users spend more time in range (3.9 mmol/L 10 mmol/L) and reduces the burden of managing diabetes compared with MDI. […] CGM improves time in range and glycaemic control. Several randomised controlled trials showed that CGM can lead to a 98% improvement in HbA1c when compared to MDI. […] SmartGuard Auto Mode is designed to determine an individuals insulin needs and to take action to reduce high and low glucose levels, to spend more time in range.

• #43 What are Automated Insulin Delivery Systems? | Medtronic

  https://www.medtronicdiabetes.com/treatments/automated-insulin-delivery

  Automated insulin delivery (AID) systems combine an insulin pump and continuous glucose monitor (CGM) to help people living with type 1 diabetes manage their blood sugar levels. […] AID systems, also known as hybrid closed loop systems, can detect changes in a persons sugar levels in real time and automatically adjust insulin doses in response. […] The CGM tracks your sugar levels every few minutes through a small sensor inserted under the skin. […] The algorithm uses current and past sugar level trends to anticipate, adjust, and correct insulin delivery. […] Its no surprise why the American Diabetes Association calls automated insulin delivery systems the standard of care for people with type 1 diabetes. […] The MiniMed 780G system is intended for continuous delivery of basal insulin at selectable rates, and the administration of insulin boluses at selectable amounts for the management of type 1 diabetes mellitus in persons seven years of age and older requiring insulin as well as for the continuous monitoring and trending of glucose levels in the fluid under the skin.

• #44 Managing Diabetes

  https://www.tandemdiabetes.com/support/diabetes-education/managing-diabetes/closed-loop-insulin-pump

  An advanced hybrid closed-loop system combines a predictive algorithm with user control. […] Some systems, such as the t:slim X2 insulin pump with Control-IQ advanced hybrid closed-loop technology, have predictive algorithms that can adjust basal rates to keep CGM blood glucose levels in a preferred range (70-180 mg/dL). […] This automatic insulin dosing is the predictive algorithm and insulin pump working in unison with CGM to help minimize the frequent decisions needed to manage type 1 diabetes. […] The fact that the user still interacts with the pump and CGM, and at times needs to instruct the pump to give extra insulin or change settings, is why these systems are called hybrid. […] Using an advanced hybrid closed-loop system offers a number of benefits over other diabetes management methods.

• #45

• #46 YpsoPump with mylife Loop – mylife Diabetescare – International

  https://www.mylife-diabetescare.com/en/mylife-loop.html

  Smartphone-based therapy management is the future of diabetes treatment. Combine the mylife YpsoPump insulin pump, the mylife CamAPS FX mobile application and the Dexcom G6, FreeStyle Libre 3 or FreeStyle Libre 3 Plus Continuous Glucose Monitoring (CGM) sensor for an automated insulin delivery system managed directly from your smartphone. […] The Automated Insulin Delivery (AID) system mylife Loop was designed to simplify diabetes management, boosting physical and mental wellbeing as much as lifestyle freedom. […] For automated insulin delivery with the mylife YpsoPump you need the mylife CamAPS FX app installed on an iPhone or Android smartphone and the Dexcom G6 or FreeStyle Libre 3 and Libre 3 Plus CGM sensor. […] The mylife CamAPS FX app is approved for people with type 1 diabetes aged one year and over, including pregnant women.

• #47 YpsoPump with mylife Loop – mylife Diabetescare – International

  https://www.mylife-diabetescare.com/en/mylife-loop.html

  The learning takes place on three levels: Overall learning, Diurnal learning (over 24 hours), and Post-meal learning. […] The use of CamAPS FX in young children aged 1 to 7 years documented clinically and statistically significant reduction of HbA1c by 0.4%, and an increase in time in target glucose range by 9% without increasing time in hypoglycaemia below 3.9 mmol/L (70 mg/dL). […] The use of the CamAPS FX control algorithm in people aged 6 years and older including adults resulted in reduction of HbA1c by 0.4%, increased time in target glucose range by 11%, and reduced time in hypoglycaemia below 3.9 mmol/L (70 mg/dL) by 0.8%. […] Control and monitoring of glucose, especially overnight, is a relief and leads to a better nights sleep. […] Thanks to its unique technology and highly adaptive capabilities, CamAPS FX demonstrated in the AiDAPT (Automated Insulin Delivery in Women with Pregnancy Complicated by Type 1 Diabetes) study that it can support women achieving their treatment goals during pregnancy, providing 10.5 % additional time in the pregnancy specific range, over the entire pregnancy period, without increasing hypoglycaemias.

• #48

• #49 CG-DME-50 Automated Insulin Delivery Systems

  https://www.anthem.com/dam/medpolicies/abc/active/guidelines/gl_pw_e002723.html

  Automated insulin delivery systems combine an insulin pump and CGM, either as separate devices or as a device that incorporates both functions. These devices may be called open-loop, hybrid closed-loop, or closed-loop. […] Hybrid closed-loop devices eliminate the requirement of routine manual adjustment of pump administration rates, with the insulin pump and CGM devices working together to predict and calculate insulin dose requirements. […] Similar to open-loop devices, there have been multiple high quality studies demonstrating significant clinical outcomes benefit from the use of hybrid closed-loop devices. […] The body of evidence to-date for the iLet closed-loop automated insulin dosing system demonstrates significant improvements in HbA1c measures, as well as time in range and time below 180 mg/dL when compared to other methods of glucose control, including multiple daily injections, sensor-augmented pump therapy and use of hybrid closed-loop devices. […] Other closed-loop systems are under investigation, but have not yet received FDA approval or clearance.

• #50 Which Hybrid Closed Loop Therapy System Is Right For Me? – Integrated Diabetes Services

  https://integrateddiabetes.com/which-hybrid-closed-loop-therapy-system-is-right-for-me/

  Algorithms that work based on user settings – (Loop/Open APS/AndroidAPS, etc). These systems are for those who desire and are knowledgeable enough to control all factors of their algorithmic adjustments. […] The Medtronic system is certainly the most alert-heavy system on the market right now. […] The Loop system is not particularly alert-heavy since the Loop system has user-set maximums and minimums. […] The Tandem system has a minimum of system alerts, and the recent update has even reduced those further. […] The Omnipod system has minimal alerts for the system. […] Asking these important questions as well as inquiring about, activities, and desired control levels are key to individualizing HCL selection. […] Because the system that may bring liberation and renewed health to one may bring depression and unforeseen hazards to another.

• #51 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39411880/

  Continuous glucose monitoring (CGM) has led to a paradigm shift in the management of pregnant women with type 1 diabetes (T1D), with improved glycaemic control, less hypoglycaemia and fewer pregnancy complications. […] In addition to CGM, other technologies, such as advanced hybrid closed-loop (AHCL) systems have further improved glycaemic management in people with T1D. AHCL therapy adapts insulin delivery via a predictive algorithm integrated with CGM and an insulin pump. A large RCT with the AHCL CamAPS FX demonstrated a 10% increase in time in range compared to standard insulin therapy in a pregnant population with T1D. […] More evidence is needed on the impact of AHCL therapy on maternal and neonatal outcomes and on which glycaemic targets with CGM should be used in pregnant women with T2D and GDM. We review the current evidence on the use of CGM and AHCL therapy in pregnancy.

• #52 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy

  https://health.learning.wiley.com/courses/dom-15999/

  Continuous glucose monitoring (CGM) has led to a paradigm shift in the management of pregnant women with type 1 diabetes (T1D), with improved glycaemic control, less hypoglycaemia and fewer pregnancy complications. […] In addition to CGM, other technologies, such as advanced hybrid closed-loop (AHCL) systems have further improved glycaemic management in people with T1D. AHCL therapy adapts insulin delivery via a predictive algorithm integrated with CGM and an insulin pump. A large RCT with the AHCL CamAPS FX demonstrated a 10% increase in time in range compared to standard insulin therapy in a pregnant population with T1D. […] Recently, an RCT of an AHCL system not approved for use in pregnancy (780G MiniMed) has also demonstrated additional benefits of AHCL therapy compared to standard insulin therapy, with improved time in range overnight, less hypoglycaemia and improved treatment satisfaction. More evidence is needed on the impact of AHCL therapy on maternal and neonatal outcomes and on which glycaemic targets with CGM should be used in pregnant women with T2D and GDM. We review the current evidence on the use of CGM and AHCL therapy in pregnancy.

• #53 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy

  https://lirias.kuleuven.be/4197058

  Continuous glucose monitoring (CGM) has led to a paradigm shift in the management of pregnant women with type 1 diabetes (T1D), with improved glycaemic control, less hypoglycaemia and fewer pregnancy complications. […] In addition to CGM, other technologies, such as advanced hybrid closed-loop (AHCL) systems have further improved glycaemic management in people with T1D. […] A large RCT with the AHCL CamAPS® FX demonstrated a 10% increase in time in range compared to standard insulin therapy in a pregnant population with T1D. […] Recently, an RCT of an AHCL system not approved for use in pregnancy (780G MiniMed) has also demonstrated additional benefits of AHCL therapy compared to standard insulin therapy, with improved time in range overnight, less hypoglycaemia and improved treatment satisfaction. […] More evidence is needed on the impact of AHCL therapy on maternal and neonatal outcomes and on which glycaemic targets with CGM should be used in pregnant women with T2D and GDM. […] We review the current evidence on the use of CGM and AHCL therapy in pregnancy.

• #54 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy

  https://lirias.kuleuven.be/4197058

  Continuous glucose monitoring (CGM) has led to a paradigm shift in the management of pregnant women with type 1 diabetes (T1D), with improved glycaemic control, less hypoglycaemia and fewer pregnancy complications. […] In addition to CGM, other technologies, such as advanced hybrid closed-loop (AHCL) systems have further improved glycaemic management in people with T1D. […] A large RCT with the AHCL CamAPS® FX demonstrated a 10% increase in time in range compared to standard insulin therapy in a pregnant population with T1D. […] Recently, an RCT of an AHCL system not approved for use in pregnancy (780G MiniMed) has also demonstrated additional benefits of AHCL therapy compared to standard insulin therapy, with improved time in range overnight, less hypoglycaemia and improved treatment satisfaction. […] More evidence is needed on the impact of AHCL therapy on maternal and neonatal outcomes and on which glycaemic targets with CGM should be used in pregnant women with T2D and GDM. […] We review the current evidence on the use of CGM and AHCL therapy in pregnancy.

• #55 Diabetes hybrid closed loop systems | HFMA

  https://www.hfma.org.uk/publications/diabetes-hybrid-closed-loop-systems-0

  By 2024, NHS England noted the success of the programme for CGM in pregnancy: The NHS diabetes programme has exceeded expectations with over 75% of the type 1 diabetes population accessing flash glucose monitoring and 98% of eligible pregnant women having been offered CGM and 78% having accepted. […] Significant numbers of patients have proven that they can manage the technical inputs appropriately, even if they take time, require confidence and headspace to make the calculations. […] Hybrid closed loop (HCL) technology enables CGM and insulin pumps to talk to each other, automating the basic glucose testing and insulin injection process, even at night preventing the need for most sleep disrupting alarms. […] Benefits of using HCL (over separate CGM and insulin pumps) include improved management of glucose levels, reduced complications in pregnancy and as a result, reduction in neonatal intensive care unit admissions, greater headspace less need to constantly be calculating, less anxiety and mental load, fewer (or no) injections and fewer finger prick tests leading to a more flexible lifestyle, confidence that there will be fewer hyperglycaemic or hypoglycaemic events, and a reduction in the risk of future events and escalation of long-term conditions.

• #56 NICE announces final appraisal recommendations on hybrid closed-loop systems for type 1 diabetes

  https://www.diabetes.org.uk/about-us/news-and-views/hybrid-closed-loop-technology-recommended-thousands-type-1

  Hybrid closed-loop has also been recommended for children and young people (under 18 years old) living with type 1 diabetes and people living with type 1 diabetes who are pregnant or planning to become pregnant. […] The guidance goes on to say that hybrid closed-loop systems should only be used with the support of a trained multidisciplinary team experienced in insulin pumps and continuous glucose monitoring in type 1 diabetes. […] Theres lots of evidence to show that the technology can help people with type 1 diabetes to improve their blood sugar levels, have less hypos and make self-managing the condition easier. […] Hybrid closed-loop technology has the potential to transform the lives of many people with type 1 diabetes, improving both health and quality of life. […] This tech might sound sci-fi like but it will have a dramatic impact on the quality of peoples lives, not to mention outcomes it is as close to the holy grail of a fully automated system as science can provide at the moment, where people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication. […] In order for most adults to be considered for hybrid closed-loop, they will need to already be using a CGM or insulin pump.

• #57 Hybrid Closed-Loop Therapy Improves Diabetes Outcomes, Study Reveals

  https://www.drugtopics.com/view/hybrid-closed-loop-therapy-improves-diabetes-outcomes-study-reveals

  Automation in closed-loop systems improves type 1 diabetes outcomes and glucose profiles in teens, according to a study published in JAMA Pediatrics. […] Six months of hybrid closed-loop therapy can significantly improve both glycemic control and quality of life in pediatric patients with type 1 diabetes (T1D), according to research results published in JAMA Pediatrics. […] Hybrid closed-loop therapy also reduced the time that patients spent in a hypoglycemic range (difference, 1.9%; 95% CI, 2.5% to 1.3%) and improved glycemic variability (5.7%; 95% CI, 10.2% to 0.9%). Hybrid closed-loop therapy was associated with improved quality of life for patients with diabetes. […] To our knowledge, this is the first randomized controlled trial in youth with T1D to provide conclusive evidence that hybrid closed-loop improves glycemic outcomes and quality of life, they concluded. The hybrid closed-loop system represents an important step in the pursuit of technological advancements towards a fully automated closed loop system.

• #58 Hybrid Closed-Loop Therapy Improves Diabetes Outcomes, Study Reveals

  https://www.drugtopics.com/view/hybrid-closed-loop-therapy-improves-diabetes-outcomes-study-reveals

  Automation in closed-loop systems improves type 1 diabetes outcomes and glucose profiles in teens, according to a study published in JAMA Pediatrics. […] Six months of hybrid closed-loop therapy can significantly improve both glycemic control and quality of life in pediatric patients with type 1 diabetes (T1D), according to research results published in JAMA Pediatrics. […] Hybrid closed-loop therapy also reduced the time that patients spent in a hypoglycemic range (difference, 1.9%; 95% CI, 2.5% to 1.3%) and improved glycemic variability (5.7%; 95% CI, 10.2% to 0.9%). Hybrid closed-loop therapy was associated with improved quality of life for patients with diabetes. […] To our knowledge, this is the first randomized controlled trial in youth with T1D to provide conclusive evidence that hybrid closed-loop improves glycemic outcomes and quality of life, they concluded. The hybrid closed-loop system represents an important step in the pursuit of technological advancements towards a fully automated closed loop system.

• #59

  https://www.healio.com/news/endocrinology/20220808/hybrid-closedloop-therapy-offers-greater-independence-for-young-people-with-diabetes

  The reduction in anxiety was attributed to lower incidences of hypoglycemia, the ability to reduce or stop insulin based on sensor glucose levels and the alarm functions with the system. […] Both parents and young people said they were less anxious about nocturnal hypoglycemia, and parents said they felt that their child was safer with the hybrid closed-loop system when they were away from home. […] Although youth commented on the alarms, notifications and the increased frequency of blood glucose monitoring as being annoying and intrusive, all youth felt that the benefits of hybrid closed-loop outweighed the extra work.

• #60

  https://www.healio.com/news/endocrinology/20220808/hybrid-closedloop-therapy-offers-greater-independence-for-young-people-with-diabetes

  Use of a hybrid closed-loop insulin delivery system provided greater independence and flexibility with glycemic management for young people with type 1 diabetes, according to study findings published in Diabetic Medicine. […] The study demonstrated an overall positive experience with improved glycemic control, less anxiety and independence with diabetes management. […] Adolescents and young adults with type 1 diabetes stated hybrid closed-loop therapy provided more independence with diabetes management while also reducing anxiety. […] Participants said they had more confidence because they were able to visualize glucose levels with the device. […] Most participants said they felt that the system gave them more independence over their diabetes management with less reliance on their parent.

• #61 Closed loop systems | Diabetes tech | Diabetes UK

  https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/technology/closed-loop-systems

  Research shows the benefits brought by closed loop systems can help give people with type 1 diabetes and people caring for them a better quality of life. […] You no longer need to do insulin injections for yourself or someone else unless there is a failure of the technology, because insulin is released via the pump. It can help prevent hypos by suspending insulin and prevent high blood sugars by increasing insulin doses. […] National guidance was published in England and Wales in December 2023 on which people with type 1 diabetes should be offered hybrid closed loop. These systems have been recommended for some adults based on their current self-management, all children and young people, and all people who are pregnant or planning pregnancy, with a phased rollout of the tech to eligible groups over five years. […] If youre already using an insulin pump and its not helping keep your blood sugar levels in range or youre having hypos, you may want to speak to your healthcare team about a hybrid closed loop system.

• #62 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?number=2703

  Continuous glucose monitoring (CGM) technology has evolved over the past decade with the integration of various devices including insulin pumps, connected insulin pens (CIPs), automated insulin delivery (AID) systems, and virtual platforms. CGM has shown consistent benefits in glycemic outcomes in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) treated with insulin. […] The combined effect of CGM and education have been shown to improve glycemic outcomes more than CGM alone. […] AID systems and virtual platforms made it possible to achieve target glycosylated hemoglobin in diabetes while minimizing hypoglycemia, which has always been challenging in T1DM. […] These advances in technology could reduce the burden associated with insulin treatment for diabetes. […] Achieving target glycosylated hemoglobin (HbA1c) while minimizing hypoglycemia has always been a challenge for diabetes treated with insulin.

• #63 Study: Closed-Loop Insulin Therapy Safe, Effective in Diabetes Requiring Dialysis – Renal and Urology News

  https://www.renalandurologynews.com/news/automated-insulin-delivery-system-promising-type-2-diabetes-hemodialysis/

  Closed-loop insulin therapy was associated with less time in hypoglycemia. […] Fully closed-loop insulin delivery improves glucose control and reduces hypoglycemia compared with standard insulin therapy in outpatients with type 2 diabetes who require dialysis. […] The wireless, automated closed-loop insulin delivery system consisted of a continuous glucose monitor, an insulin pump, and a control algorithm with a glucose target set at a median 7.3 mmol/L (132 mg/dL). […] Closed-loop insulin delivery was associated with a significantly higher proportion of time in the target glucose range of 5.6 to 10.0mmol/L (100 to 180 mg/dL), compared with standard insulin therapy: 52.8% vs 37.7%. […] Time in hypoglycemia (less than 3.9 mmol/L or 70 mg/dL) was significantly reduced with closed-loop versus standard insulin therapy: median 0.1% vs 0.2%.

• #64 Fully automated closed-loop glucose control compared with standard insulin therapy in adults with type 2 diabetes requiring dialysis: an open-label, randomized crossover trial | Nature Medicine

  https://www.nature.com/articles/s41591-021-01453-z

  We evaluated the safety and efficacy of fully closed-loop insulin therapy compared with standard insulin therapy in adults with type 2 diabetes requiring dialysis. […] Fully closed-loop improved glucose control and reduced hypoglycemia compared with standard insulin therapy in adult outpatients with type 2 diabetes requiring dialysis. […] Closed-loop insulin delivery systems comprise a continuous glucose monitor, an insulin pump and a control algorithm that continuously and automatically modulates subcutaneous insulin delivery in response to real-time interstitial glucose concentrations. […] In the present study, we address this issue and hypothesize that fully closed-loop insulin delivery may improve glycemic control compared to standard insulin therapy without increasing the risk of hypoglycemia in people with type 2 diabetes and ESRD undergoing maintenance dialysis in the outpatient setting.

• #65 Study: Closed-Loop Insulin Therapy Safe, Effective in Diabetes Requiring Dialysis – Renal and Urology News

  https://www.renalandurologynews.com/news/automated-insulin-delivery-system-promising-type-2-diabetes-hemodialysis/

  Closed-loop insulin therapy was associated with less time in hypoglycemia. […] Fully closed-loop insulin delivery improves glucose control and reduces hypoglycemia compared with standard insulin therapy in outpatients with type 2 diabetes who require dialysis. […] The wireless, automated closed-loop insulin delivery system consisted of a continuous glucose monitor, an insulin pump, and a control algorithm with a glucose target set at a median 7.3 mmol/L (132 mg/dL). […] Closed-loop insulin delivery was associated with a significantly higher proportion of time in the target glucose range of 5.6 to 10.0mmol/L (100 to 180 mg/dL), compared with standard insulin therapy: 52.8% vs 37.7%. […] Time in hypoglycemia (less than 3.9 mmol/L or 70 mg/dL) was significantly reduced with closed-loop versus standard insulin therapy: median 0.1% vs 0.2%.

• #66 Study: Closed-Loop Insulin Therapy Safe, Effective in Diabetes Requiring Dialysis – Renal and Urology News

  https://www.renalandurologynews.com/news/automated-insulin-delivery-system-promising-type-2-diabetes-hemodialysis/

  Patients reported benefits of the closed loop system that included a reduced need for finger-prick glucose checks and less time spent managing diabetes. […] Having demonstrated safety and efficacy in this at-risk population in this exploratory study, larger studies are now required to confirm these findings and to determine if the glycemic improvements observed with closed-loop are associated with a reduction in complications and improved quality of life.

• #67 Diabetes technology: A primer for clinicians | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/6/353

  Hybrid closed-loop systems use readings from a CGM and deliver basal insulin using a proprietary algorithm, with or without the need to input basal insulin rates into the pump. […] Examples of hybrid closed-loop pumps include MiniMed 670G, 770G, and 780G, t:slim X2, Mobi with Control-IQ, and Omnipod 5. […] Automated insulin delivery systems are now the standard of care for patients living with type 1 diabetes. […] The American Diabetes Association recommends that automated insulin delivery systems be offered to patients with type 1 and other forms of insulin-deficient diabetes, with the choice based on the patients circumstances, preferences, and needs.

• #68 At a glance factsheet: Hybrid closed-loop therapy – DiabetesontheNet

  https://diabetesonthenet.com/diabetes-primary-care/factsheet-hybrid-closed-loop-therapy/

  Most importantly, HCL is associated with improved quality of life; generally positive user experience, including reassurance and reduced anxiety; improved sleep and confidence; and a reduction in the demands of living with type 1 diabetes. […] NICE TA943 guidance recommends HCL systems as an option for managing blood glucose levels in children and young people with type 1 diabetes, people with type 1 diabetes who are pregnant or planning pregnancy, and adults with type 1 diabetes who have HbA1c 58 mmol/mol (7.5%) or disabling hypoglycaemia despite best possible management with at least one of the following: Continuous subcutaneous insulin infusion (CSII), Real-time CGM, Intermittently scanned CGM. […] The NICE TA943 recommendations have the potential to substantially change the management and improve the outcomes of people living with type 1 diabetes across England.

• #69 NICE announces final appraisal recommendations on hybrid closed-loop systems for type 1 diabetes

  https://www.diabetes.org.uk/about-us/news-and-views/hybrid-closed-loop-technology-recommended-thousands-type-1

  A landmark announcement by the National Institute of Health Care and Excellence (NICE) outlines details of who will be offered hybrid closed-loop technology in England and Wales. […] NICE have published the outcome of their appraisal for hybrid closed-loop systems recommending that over the next five years hundreds of thousands of people living with type 1 diabetes should be offered this next-generation technology to help them manage their condition. […] Under the new recommendations, hybrid closed-loop has been recommended for adults living with type 1 diabetes who have an HbA1c of 58 mmol/mol (7.5%) or higher, or have disabling hypoglycaemia, despite best possible management with at least one of the following: Continuous subcutaneous insulin infusion (CSII) (i.e. an insulin pump), Real-time continuous glucose monitoring (CGM), Intermittently scanned continuous glucose monitoring (Flash).

• #70 NICE announces final appraisal recommendations on hybrid closed-loop systems for type 1 diabetes

  https://www.diabetes.org.uk/about-us/news-and-views/hybrid-closed-loop-technology-recommended-thousands-type-1

  Hybrid closed-loop has also been recommended for children and young people (under 18 years old) living with type 1 diabetes and people living with type 1 diabetes who are pregnant or planning to become pregnant. […] The guidance goes on to say that hybrid closed-loop systems should only be used with the support of a trained multidisciplinary team experienced in insulin pumps and continuous glucose monitoring in type 1 diabetes. […] Theres lots of evidence to show that the technology can help people with type 1 diabetes to improve their blood sugar levels, have less hypos and make self-managing the condition easier. […] Hybrid closed-loop technology has the potential to transform the lives of many people with type 1 diabetes, improving both health and quality of life. […] This tech might sound sci-fi like but it will have a dramatic impact on the quality of peoples lives, not to mention outcomes it is as close to the holy grail of a fully automated system as science can provide at the moment, where people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication. […] In order for most adults to be considered for hybrid closed-loop, they will need to already be using a CGM or insulin pump.

• #71 NICE announces final appraisal recommendations on hybrid closed-loop systems for type 1 diabetes

  https://www.diabetes.org.uk/about-us/news-and-views/hybrid-closed-loop-technology-recommended-thousands-type-1

  Hybrid closed-loop has also been recommended for children and young people (under 18 years old) living with type 1 diabetes and people living with type 1 diabetes who are pregnant or planning to become pregnant. […] The guidance goes on to say that hybrid closed-loop systems should only be used with the support of a trained multidisciplinary team experienced in insulin pumps and continuous glucose monitoring in type 1 diabetes. […] Theres lots of evidence to show that the technology can help people with type 1 diabetes to improve their blood sugar levels, have less hypos and make self-managing the condition easier. […] Hybrid closed-loop technology has the potential to transform the lives of many people with type 1 diabetes, improving both health and quality of life. […] This tech might sound sci-fi like but it will have a dramatic impact on the quality of peoples lives, not to mention outcomes it is as close to the holy grail of a fully automated system as science can provide at the moment, where people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication. […] In order for most adults to be considered for hybrid closed-loop, they will need to already be using a CGM or insulin pump.

• #72 Types of Treatment for Diabetes – DOH/HSCNI Strategic Planning and Performance Group (SPPG)

  https://online.hscni.net/partnerships/diabetes-network/diabetes-network-programmes/regional-insulin-pump-service/types-of-treatment-for-diabetes/

  Hybrid Closed Loop (HCL) systems use a mathematical process to deliver insulin automatically by calculating the amount of insulin someone needs based on continuously monitored blood sugar readings so the pump can automatically give accurate and timely doses. […] NICE recommends that HCL systems can be used as an option for managing blood glucose levels in Type 1 diabetes for adults who have an HbA1c of 58 mmol/mol (7.5%) or more, or have disabling hypoglycaemia, despite best possible management with at least 1 of the following: continuous subcutaneous insulin infusion (CSII) real-time continuous glucose monitoring (rtCGM) intermittently scanned continuous glucose monitoring (isCGM). […] In December 2023, the National Institute for Health and Care Excellence (NICE) Clinical updated guidance with recommendations on the use of Hybrid Closed Loop (HCL) systems.

• #73 Diabetes technology: A primer for clinicians | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/6/353

  Hybrid closed-loop systems use readings from a CGM and deliver basal insulin using a proprietary algorithm, with or without the need to input basal insulin rates into the pump. […] Examples of hybrid closed-loop pumps include MiniMed 670G, 770G, and 780G, t:slim X2, Mobi with Control-IQ, and Omnipod 5. […] Automated insulin delivery systems are now the standard of care for patients living with type 1 diabetes. […] The American Diabetes Association recommends that automated insulin delivery systems be offered to patients with type 1 and other forms of insulin-deficient diabetes, with the choice based on the patients circumstances, preferences, and needs.

• #74 NICE announces final appraisal recommendations on hybrid closed-loop systems for type 1 diabetes

  https://www.diabetes.org.uk/about-us/news-and-views/hybrid-closed-loop-technology-recommended-thousands-type-1

  Hybrid closed-loop has also been recommended for children and young people (under 18 years old) living with type 1 diabetes and people living with type 1 diabetes who are pregnant or planning to become pregnant. […] The guidance goes on to say that hybrid closed-loop systems should only be used with the support of a trained multidisciplinary team experienced in insulin pumps and continuous glucose monitoring in type 1 diabetes. […] Theres lots of evidence to show that the technology can help people with type 1 diabetes to improve their blood sugar levels, have less hypos and make self-managing the condition easier. […] Hybrid closed-loop technology has the potential to transform the lives of many people with type 1 diabetes, improving both health and quality of life. […] This tech might sound sci-fi like but it will have a dramatic impact on the quality of peoples lives, not to mention outcomes it is as close to the holy grail of a fully automated system as science can provide at the moment, where people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication. […] In order for most adults to be considered for hybrid closed-loop, they will need to already be using a CGM or insulin pump.

• #75 Association of British Clinical Diabetologist’s Diabetes Technology Network (ABCD-DTN): Best practice guide for hybrid closed-loop therapy | The Association of British Clinical Diabetologists

  https://abcd.care/announcement/association-british-clinical-diabetologists-diabetes-technology-network-abcd-dtn-best

  As healthcare professionals, we strive to provide the best possible care for people with type 1 diabetes. One of the most challenging aspects of managing this condition is achieving and maintaining blood glucose levels within a safe and healthy range. The development of hybrid closed-loop systems, which combine continuous glucose monitoring and insulin pump therapy with advanced algorithms to automate insulin delivery, represents a significant advance in diabetes care. […] The implementation of hybrid closed-loop systems has been shown to improve glucose levels, reduce the risk of hypoglycaemia, and enhance quality of life for people with type 1 diabetes. […] This best practice guide covering commercially available hybrid closed-loop systems in type 1 diabetes is a timely and important resource for healthcare professionals given the anticipated increase in access and availability of funding for these systems in the UK, including the upcoming NICE multiple-technology appraisal in England. […] By following the recommendations outlined in this guide, healthcare professionals can help ensure that people with type 1 diabetes receive the maximum benefit from hybrid closed-loop systems while minimising the risk of complications.

• #76 NICE announces final appraisal recommendations on hybrid closed-loop systems for type 1 diabetes

  https://www.diabetes.org.uk/about-us/news-and-views/hybrid-closed-loop-technology-recommended-thousands-type-1

  Hybrid closed-loop has also been recommended for children and young people (under 18 years old) living with type 1 diabetes and people living with type 1 diabetes who are pregnant or planning to become pregnant. […] The guidance goes on to say that hybrid closed-loop systems should only be used with the support of a trained multidisciplinary team experienced in insulin pumps and continuous glucose monitoring in type 1 diabetes. […] Theres lots of evidence to show that the technology can help people with type 1 diabetes to improve their blood sugar levels, have less hypos and make self-managing the condition easier. […] Hybrid closed-loop technology has the potential to transform the lives of many people with type 1 diabetes, improving both health and quality of life. […] This tech might sound sci-fi like but it will have a dramatic impact on the quality of peoples lives, not to mention outcomes it is as close to the holy grail of a fully automated system as science can provide at the moment, where people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication. […] In order for most adults to be considered for hybrid closed-loop, they will need to already be using a CGM or insulin pump.

• #77 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?doi=10.4093/dmj.2022.0271

  However, technological advances including continuous glucose monitoring (CGM), connected insulin pens (CIPs), insulin pumps, and automated insulin delivery (AID) algorithms combined with education have made it possible to achieve the optimal control of diabetes using insulin. […] The effectiveness of rtCGM has been confirmed in various randomized controlled trials (RCTs) with different types of diabetes and insulin regimens. […] The glycemic outcome was different based on the glycemic status of the study population included. […] The use of rtCGM reduces HbA1c by about 0.3% to 0.6%. […] The use of rtCGM without education limits better glycemic outcomes. […] Today, structured education specifically for CGM has been recognized as an essential part of diabetes therapy. […] The CIP is a new technology with a function that displays the last dose of insulin and timing and has reminder alerts that integrate with a smart app.

• #78

  https://link.springer.com/article/10.1007/s00592-021-01820-9

  The study aims at evaluating glucose metrics and HbA1C values after pump initiation in outpatient settings. […] This single center observational study enrolled 121 subjects with type 1 diabetes between September 2020 and May 2021 initiating sensor-augmented pump therapy with stand-alone CGM or pump users who only changed their device, with predictive low glucose management or with Hybrid Closed Loop using Medtronic 780G systems. Changes in HbA1C levels and glucose metrics were analyzed after 3 months. […] While only 18/121 (14.8%) participants reached initially the recommended HbA1C levels, 23/85 (27%) in the conventional group and 33/36 (91%) subjects in the Hybrid Closed Loop group reached target levels after 3 months of follow-up. […] Telehealth monitoring after outpatient initiation provides tools for improvement in glucose control with an insulin pump. Outpatient pump initiation is compatible with Hybrid Closed Loop systems which provide the largest improvements in glucose control.

• #79 Types of Treatment for Diabetes – DOH/HSCNI Strategic Planning and Performance Group (SPPG)

  https://online.hscni.net/partnerships/diabetes-network/diabetes-network-programmes/regional-insulin-pump-service/types-of-treatment-for-diabetes/

  Additional funding is not automatically provided to support the rollout of the NICE guidance. Funding is required for the devices as well as resources to upskill and recruit the workforce needed to offer Hybrid Closed Loop widely and equitably across the region. […] NICE have recommended that Hybrid Closed Loop (HCL) technology should be offered as an option for managing blood glucose in Type 1 Diabetes if other methods have not achieved the desired results. […] The Regional Insulin Pump Service has been fully operational since March 2024 and will support the implementation of the NICE guidance once an implementation plan is finalised and additional investment has been agreed.

• #80 NHS England » Hybrid closed loop technology

  https://www.england.nhs.uk/diabetes/digital-innovations-to-support-diabetes-outcomes/hybrid-closed-loop-technology/

  Hybrid closed loop (HCL) systems link continuous glucose monitoring (CGM) with insulin pump technology to monitor blood glucose and automatically adjust the amount of insulin given through a pump to people living with type 1 diabetes. […] HCL can eliminate finger-prick tests and prevent life-threatening hypoglycaemic and hyperglycaemia attacks, which can lead to seizures, coma or even death for people living with type 1 diabetes. […] Following a successful pilot by NHS England, in December 2023 the National Institute for Health and Care Excellence recommended that HCL technology should be rolled-out in a phased implementation, over the next 5 years, to thousands of patients including: […] The first phase of the roll-out to NHS integrated care systems will begin from April 2024. All patients who are eligible should continue to attend appointments as normal and discuss options with their diabetes team.

• #81 Continuous glucose monitoring and hybrid closed loop for diabetes – NHS

  https://www.nhs.uk/conditions/cgm-and-hcl-for-diabetes/

  Hybrid closed loop is planned to be available to all children and young people with type 1 diabetes, and eventually to adults with type 1 diabetes who either: have blood glucose levels (HbA1c levels) of 58 mmol/mol or more, have serious problems with hypos despite using an insulin pump or CGM on its own and carefully trying to manage their blood glucose, are pregnant or planning to get pregnant. […] Insulin pumps and hybrid closed loop systems are not currently available on the NHS for people with type 2 diabetes.

• #82 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?doi=10.4093/dmj.2022.0271

  Currently, a few clinical trials are collecting data on the effectiveness of these CIPs. […] Increasing evidence demonstrates the effectiveness of insulin pumps when used in combination with a CGM and closed-loop algorithm controller to automate basal insulin delivery, these are known as HCLS. […] The outcomes are well summarized in the review article by Moon et al. […] Thus, this review only includes updated clinical trials beyond the previous review article. […] The development of diabetes technology made it possible to avoid hyperglycemia without increasing hypoglycemia with a more comfortable fit and less effort, which could not previously be shown in diabetes with insulin therapy. […] In the future, we expect that a fully automatic AID system will emerge, just as Bionic Pancreas has developed no carbohydrate counting pumps, which was previously burdensome for users. […] There is no doubt that evolving diabetes technology has changed the treatment paradigm for patients with diabetes using insulin treatment and reduced the burden of diabetes self-management such as the adjustment of insulin dosing.

• #83 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?number=2703

  Increasing evidence demonstrates the effectiveness of insulin pumps when used in combination with a CGM and closed-loop algorithm controller to automate basal insulin delivery, these are known as HCLS. […] The outcomes are well summarized in the review article by Moon et al. […] Thus, this review only includes updated clinical trials beyond the previous review article. […] The development of diabetes technology made it possible to avoid hyperglycemia without increasing hypoglycemia with a more comfortable fit and less effort, which could not previously be shown in diabetes with insulin therapy. […] In the future, we expect that a fully automatic AID system will emerge, just as Bionic Pancreas has developed no carbohydrate counting pumps, which was previously burdensome for users. […] However, most of the HCLS still need to modify a variety of parameters including carbohydrate counting, and these require expertise and experience from the HCP. […] Thus, constant efforts for developing AI-based personalized decision support such as DreaMed advisor, which recommends adjustments to the CF, ICR, and basal rate automatically, are needed to optimize insulin use in diabetes aiming to accomplish the greatest TIR with no hypoglycemia.

• #84 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?number=2703

  Increasing evidence demonstrates the effectiveness of insulin pumps when used in combination with a CGM and closed-loop algorithm controller to automate basal insulin delivery, these are known as HCLS. […] The outcomes are well summarized in the review article by Moon et al. […] Thus, this review only includes updated clinical trials beyond the previous review article. […] The development of diabetes technology made it possible to avoid hyperglycemia without increasing hypoglycemia with a more comfortable fit and less effort, which could not previously be shown in diabetes with insulin therapy. […] In the future, we expect that a fully automatic AID system will emerge, just as Bionic Pancreas has developed no carbohydrate counting pumps, which was previously burdensome for users. […] However, most of the HCLS still need to modify a variety of parameters including carbohydrate counting, and these require expertise and experience from the HCP. […] Thus, constant efforts for developing AI-based personalized decision support such as DreaMed advisor, which recommends adjustments to the CF, ICR, and basal rate automatically, are needed to optimize insulin use in diabetes aiming to accomplish the greatest TIR with no hypoglycemia.

• #85 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?number=2703

  Increasing evidence demonstrates the effectiveness of insulin pumps when used in combination with a CGM and closed-loop algorithm controller to automate basal insulin delivery, these are known as HCLS. […] The outcomes are well summarized in the review article by Moon et al. […] Thus, this review only includes updated clinical trials beyond the previous review article. […] The development of diabetes technology made it possible to avoid hyperglycemia without increasing hypoglycemia with a more comfortable fit and less effort, which could not previously be shown in diabetes with insulin therapy. […] In the future, we expect that a fully automatic AID system will emerge, just as Bionic Pancreas has developed no carbohydrate counting pumps, which was previously burdensome for users. […] However, most of the HCLS still need to modify a variety of parameters including carbohydrate counting, and these require expertise and experience from the HCP. […] Thus, constant efforts for developing AI-based personalized decision support such as DreaMed advisor, which recommends adjustments to the CF, ICR, and basal rate automatically, are needed to optimize insulin use in diabetes aiming to accomplish the greatest TIR with no hypoglycemia.

• #86 Hybrid Closed-Loop System Favorable for Type 1 Diabetes

  https://www.pharmacytimes.com/view/hybrid-closedloop-system-favorable-for-type-1-diabetes

  Single-and dual-hormone closed-loop systems automate the dosing of insulin or insulin plus glucagon in patients with type 1 diabetes. Automated delivery of the drugs during exercise can result in better control of blood glucose by reducing insulin and increasing glucagon, according to the session. […] Our findings show that fully automated insulin and glucagon delivery, combined with wearable physical activity sensors that detect exercise, effectively controlled glucose levels, reduced exercise-induced hypoglycemia and can safely be used in a home environment, said investigator Peter G. Jacobs, PhD. These results suggest that a dual-hormone closed-loop system with automated detection of aerobic exercise can be used as a tool to adjust dosing of insulin and glucagon during and after exercise. […] These findings suggest that the dual-hormone closed-loop system should be used for patients with type 1 diabetes who are at risk of exercise-induced hypoglycemia.

• #87 Advanced Technology (Continuous Glucose Monitoring and Advanced Hybrid Closed-Loop Systems) in Diabetes from the Perspective of Gender Differences

  https://www.mdpi.com/2673-4540/4/4/45

  Although sex and gender differences have emerged regarding the prevalence of use and adherence to therapy with advanced technologies, the perceived benefits for both sexes were better glycaemic control, the prevention of long-term complications, better quality of life, and reduced mental burden related to diabetes.

• #88 A Hybrid Closed-loop Insulin Delivery System for Blood Sugar Control in Patients with High-risk Acute Lymphoblastic Leukemia Undergoing Chemotherapy – NCIFacebookFollow on XInstagramYoutubeLinkedin

  https://www.cancer.gov/about-cancer/treatment/clinical-trials/search/v?id=NCI-2022-03110

  This clinical trial evaluates whether a new hybrid closed-loop insulin delivery system can safely be used to treat blood sugar problems in patients being treated for high-risk acute lymphoblastic leukemia (ALL). […] The Tandem Control-IQ Professional Hybrid Closed Loop artificial pancreas system is a new method of glucose control that automatically modulates insulin delivery to minimize both low and high blood sugar through continuous glucose monitoring and insulin delivery via a pump. […] Using a hybrid closed-loop insulin delivery system may help manage blood sugar levels and reduce chemotherapy complications in patients with ALL undergoing chemotherapy. […] PRIMARY OBJECTIVES: I. To examine the safety of hybrid closed-loop (HCL) insulin delivery in children and young adults with acute lymphoblastic leukemia during the induction chemotherapy phase as assessed by hypoglycemia exposure (blood glucose < 70 mg/dL), and rates of bleeding and infection at the insulin infusion and continuous glucose monitoring (CGM) site.

• #89 Types of Treatment for Diabetes – DOH/HSCNI Strategic Planning and Performance Group (SPPG)

  https://online.hscni.net/partnerships/diabetes-network/diabetes-network-programmes/regional-insulin-pump-service/types-of-treatment-for-diabetes/

  Additional funding is not automatically provided to support the rollout of the NICE guidance. Funding is required for the devices as well as resources to upskill and recruit the workforce needed to offer Hybrid Closed Loop widely and equitably across the region. […] NICE have recommended that Hybrid Closed Loop (HCL) technology should be offered as an option for managing blood glucose in Type 1 Diabetes if other methods have not achieved the desired results. […] The Regional Insulin Pump Service has been fully operational since March 2024 and will support the implementation of the NICE guidance once an implementation plan is finalised and additional investment has been agreed.

• #90 Diabetes hybrid closed loop systems | HFMA

  https://www.hfma.org.uk/publications/diabetes-hybrid-closed-loop-systems-0

  NICE made evidence-based recommendations for the HCL technology for NHS patients in December 2023. […] NICE states that trial and real-world evidence shows that HCL systems are more effective than standard care at maintaining blood glucose levels within a healthy range. […] NICE concluded that HCL systems would reduce some of this burden, and improve quality of life for people, their families and carers. […] The HCL can also be used by a much wider range of people than is appropriate for separate CGM and insulin pump technology, because it lessens the number of manual calculations made with the separate technologies. […] The NICE programme estimated the cost over a 60-year time horizon with the patients HbA1C score (time in range) assumed to remain constant. […] The NICE analysts modelled the impact of avoiding adverse events and complications, including AE attendance, admission for severe and non-severe hypo or hyper glycaemic event, non-fatal stroke, fatal stroke, kidney complications and eye complications. […] The NICE model shown uses a value called an incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY).

• #91 NICE announces final appraisal recommendations on hybrid closed-loop systems for type 1 diabetes

  https://www.diabetes.org.uk/about-us/news-and-views/hybrid-closed-loop-technology-recommended-thousands-type-1

  Hybrid closed-loop has also been recommended for children and young people (under 18 years old) living with type 1 diabetes and people living with type 1 diabetes who are pregnant or planning to become pregnant. […] The guidance goes on to say that hybrid closed-loop systems should only be used with the support of a trained multidisciplinary team experienced in insulin pumps and continuous glucose monitoring in type 1 diabetes. […] Theres lots of evidence to show that the technology can help people with type 1 diabetes to improve their blood sugar levels, have less hypos and make self-managing the condition easier. […] Hybrid closed-loop technology has the potential to transform the lives of many people with type 1 diabetes, improving both health and quality of life. […] This tech might sound sci-fi like but it will have a dramatic impact on the quality of peoples lives, not to mention outcomes it is as close to the holy grail of a fully automated system as science can provide at the moment, where people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication. […] In order for most adults to be considered for hybrid closed-loop, they will need to already be using a CGM or insulin pump.

• #92 Diabetes Technology: A Primer for Clinicians

  https://consultqd.clevelandclinic.org/diabetes-technology-a-primer-for-clinicians

  Examples of hybrid closed-loop pumps include MiniMed 670G, 770G and 780G, t:slim X2, Mobi with Control-IQ, and Omnipod 5. […] The FDA has also cleared the Dexcom G7, Freestyle Libre 2 Plus and Libre 3 CGMs, as well as interoperable CGMs (which can integrate with insulin pumps from various manufacturers), for integration with certain insulin pumps. […] The iLet Bionic Pancreas, a hybrid closed-loop insulin pump, was cleared by the FDA in May 2023 for patients with Type 1 diabetes. […] Do-it-yourself hybrid closed-loop systems are open-source software systems that use a smartphone application and bridging devices to simulate hybrid closed-loop communication between a CGM and insulin pump. […] Closed-loop systems, currently being researched and not yet available, would require no user input and ideally would calculate mealtime bolus dosing automatically.

• #93 Study Explores Effect of Hybrid Closed-Loop Therapy on Diabetic Complications

  https://www.endocrinologyadvisor.com/news/study-explores-effect-of-hybrid-closed-loop-therapy-on-diabetic-complications/

  Hybrid closed-loop insulin delivery does not affect rate of severe hypoglycemia and increases rate of ketoacidosis. […] For young people with type 1 diabetes, hybrid closed-loop insulin delivery does not affect the rate of severe hypoglycemia and is associated with an increased risk for diabetic ketoacidosis, but it is also associated with a lower risk for hypoglycemic coma, according to a study published online in the February issue of The Lancet Diabetes Endocrinology. […] The researchers found that the rate of ketoacidosis was higher for those using closed- versus open-loop therapy (1.74 versus 0.96 per 100 patient-years; incidence rate ratio, 1.81), while there was no significant between-group difference in the rate of severe hypoglycemia. […] The rate of hypoglycemic coma was significantly lower for individuals using closed- versus open-loop therapy (0.62 versus 0.91 per 100 patient-years; incidence rate ratio, 0.68).

• #94 Which Hybrid Closed Loop Therapy System Is Right For Me? – Integrated Diabetes Services

  https://integrateddiabetes.com/which-hybrid-closed-loop-therapy-system-is-right-for-me/

  Algorithms that work based on user settings – (Loop/Open APS/AndroidAPS, etc). These systems are for those who desire and are knowledgeable enough to control all factors of their algorithmic adjustments. […] The Medtronic system is certainly the most alert-heavy system on the market right now. […] The Loop system is not particularly alert-heavy since the Loop system has user-set maximums and minimums. […] The Tandem system has a minimum of system alerts, and the recent update has even reduced those further. […] The Omnipod system has minimal alerts for the system. […] Asking these important questions as well as inquiring about, activities, and desired control levels are key to individualizing HCL selection. […] Because the system that may bring liberation and renewed health to one may bring depression and unforeseen hazards to another.

• #95 NHMRC Clinical Trial Centre | Improving Health Outcomes

  https://ctc.usyd.edu.au/our-impact/case-studies-and-examples/case-studies-and-examples/hybrid-closed-loop-study/

  A Hybrid Closed Loop Pump rapidly adjusts insulin delivery according to glucose levels measured by a special sensor the patient or carer inserts under the skin each week. It uses a sophisticated algorithm inferring the direction of glucose level change and adjusting the insulin dose accordingly. […] In adults with type 1 diabetes, 26 weeks of HCL improved TIR, HbA1c, and their sense of satisfaction from managing their diabetes compared with those continuing with user-determined insulin dosing and self-monitoring of blood glucose. […] For most people living with type 1 diabetes globally, this trial demonstrates that HCL is feasible, acceptable, and advantageous.

• #96 Hybrid Closed Loop Therapy – Advanced Therapeutics (UK) Ltd

  https://www.advancedtherapeutics.org.uk/hybrid-closed-loop-therapy/

  The system’s ability to adapt to changing circumstances means that it can support individuals through various situations, offering peace of mind and improved quality of life. […] Hybrid Closed Loop Therapy represents a monumental leap in Type 1 diabetes care, revolutionising how individuals manage their condition. By integrating continuous glucose monitoring with insulin delivery, this technology offers a level of precision and control that was once beyond imagination. For those living with Type 1 diabetes, this means newfound freedom and confidence in navigating daily life.

• #97 Six months of hybrid closed-loop therapy improves diabetes-specific positive well-being, and reduces diabetes distress and fear of hypoglycemia: secondary analysis of a randomized controlled trial | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/12/6/e004428

  In this 26-week, open-label, RCT of HCL versus standard therapy (CSII or MDI without real-time CGM), those allocated to HCL reported significantly greater diabetes-specific positive well-being at 13-week follow-up, which was maintained at 26 weeks. […] Adjusted analyses also showed reduced diabetes distress and fear of hypoglycemia (maintain high and worry subscales) favoring HCL. […] These novel findings demonstrate that HCL offers important psychological benefits over standard therapy to adults with T1D.

• #98 At a glance factsheet: Hybrid closed-loop therapy – DiabetesontheNet

  https://diabetesonthenet.com/diabetes-primary-care/factsheet-hybrid-closed-loop-therapy/

  Most importantly, HCL is associated with improved quality of life; generally positive user experience, including reassurance and reduced anxiety; improved sleep and confidence; and a reduction in the demands of living with type 1 diabetes. […] NICE TA943 guidance recommends HCL systems as an option for managing blood glucose levels in children and young people with type 1 diabetes, people with type 1 diabetes who are pregnant or planning pregnancy, and adults with type 1 diabetes who have HbA1c 58 mmol/mol (7.5%) or disabling hypoglycaemia despite best possible management with at least one of the following: Continuous subcutaneous insulin infusion (CSII), Real-time CGM, Intermittently scanned CGM. […] The NICE TA943 recommendations have the potential to substantially change the management and improve the outcomes of people living with type 1 diabetes across England.

• #99

  https://link.springer.com/article/10.1007/s13300-021-01160-5

  Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) are two diabetes technologies that have revolutionized diabetes care, with both technologies associated with improved HbA1c levels, increased TIR, and fewer hypoglycemic events compared with MDI. […] HCL systems represent the most advanced and the most effective form of insulin delivery currently available for people with T1D. However, novel diabetes technologies are often underutilized, particularly in Central and Eastern Europe. […] Wider use of diabetes technologies, including HCL systems, would provide clear glycemic control benefits for people with T1D, while decreasing the self-management burden with automated insulin delivery. […] The present position statement emphasizes the endeavor of the healthcare community to ensure that individuals with T1D gain access to efficacious technology in a timely and economically responsible manner, thereby improving key health outcomes such as glycemic control and quality of life.

• #100 Association of British Clinical Diabetologist’s Diabetes Technology Network (ABCD-DTN): Best practice guide for hybrid closed-loop therapy | The Association of British Clinical Diabetologists

  https://abcd.care/announcement/association-british-clinical-diabetologists-diabetes-technology-network-abcd-dtn-best

  As healthcare professionals, we strive to provide the best possible care for people with type 1 diabetes. One of the most challenging aspects of managing this condition is achieving and maintaining blood glucose levels within a safe and healthy range. The development of hybrid closed-loop systems, which combine continuous glucose monitoring and insulin pump therapy with advanced algorithms to automate insulin delivery, represents a significant advance in diabetes care. […] The implementation of hybrid closed-loop systems has been shown to improve glucose levels, reduce the risk of hypoglycaemia, and enhance quality of life for people with type 1 diabetes. […] This best practice guide covering commercially available hybrid closed-loop systems in type 1 diabetes is a timely and important resource for healthcare professionals given the anticipated increase in access and availability of funding for these systems in the UK, including the upcoming NICE multiple-technology appraisal in England. […] By following the recommendations outlined in this guide, healthcare professionals can help ensure that people with type 1 diabetes receive the maximum benefit from hybrid closed-loop systems while minimising the risk of complications.

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