Evidence map›Paper›PMID 41527459›Full record

SynthesisDiabetic medicine : a journal of the British Diabetic Association2026

Hybrid closed-loop insulin delivery improves glycaemic control compared with sensor-augmented pump therapy: A meta-analysis of 'free-living' randomised trials in type 1 diabetes.

Amardeep S Sidki, Patrick J Highton, Lauren L O'Mahoney, Thomas J Wilkinson

Abstract readMeta-AnalysisComparative StudyReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Diabetic medicine : a journal of the British Diabetic Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Amardeep S SidkiDiabetes Research Centre, University of Leicester, Leicester, UK.ORCID https://orcid.org/0000-0002-3342-2336
Patrick J HightonDiabetes Research Centre, University of Leicester, Leicester, UK.ORCID https://orcid.org/0000-0002-0410-5788
Lauren L O'MahoneyDiabetes Research Centre, University of Leicester, Leicester, UK.ORCID https://orcid.org/0000-0002-2786-3290
Thomas J WilkinsonDiabetes Research Centre, University of Leicester, Leicester, UK.ORCID https://orcid.org/0000-0002-7855-7752

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimAlthough hybrid closed-loop systems (HCLS) and sensor-augmented pump (SAP) therapy are advanced diabetes management technologies for type 1 diabetes, their relative efficacy in optimising glycaemic control is not fully established. This meta-analysis evaluated the impact of HCLS versus SAP therapy on glucose regulation across multiple randomised controlled trials (RCTs) and randomised crossover trials (RCOs). The primary aim was to determine the efficacy of HCLS in improving glycaemic control, reducing glucose variability and enhancing time in range (TIR) compared with SAP therapy.

methodsThe review was prospectively registered with the International Prospective Register of Systematic Reviews as CRD42023488722. Data from 27 studies involving over 1000 participants were analysed. The studies included both RCTs and RCOs that compared HCLS with SAP therapy. Key metrics assessed were mean glucose levels, glucose variability (coefficient of variation and standard deviation), low blood glucose index (LBGI), high blood glucose index (HBGI), glycated haemoglobin (HbA1c) and TIR (3.9-10.0 mmol/L). Hyperglycaemia and hypoglycaemia outcomes were also evaluated.

resultsHCLS significantly reduced mean glucose levels by 2.0 mg/dL compared with SAP therapy. It also decreased glucose variability, including CV and SD, and reduced LBGI, HBGI and HbA1c. HCLS increased TIR by 8.8%. Regarding hyperglycaemia, HCLS reduced the time spent above 10 mmol/L by 7.8%, above 13.9 mmol/L by 3.63% and above 16.7 mmol/L by 0.88%. Hypoglycaemia outcomes showed modest improvements, with reductions in time below 3 mmol/L by 0.10% and below 3.9 mmol/L by 0.72%.

conclusionsOur findings support HCLS as a superior modality to SAP therapy in improving glycaemic control, particularly in paediatric populations. HCLS effectively reduces hyperglycaemia and increases TIR, with modest effects on hypoglycaemia. The clinical implications are significant, highlighting the advantages of HCLS in optimising glucose regulation and mitigating glycaemic variability. This technology offers improved glycaemic control and enhanced quality of life for people living with type 1 diabetes.

Indexed as

Diabetes Mellitus, Type 1Glycemic ControlHypoglycemic AgentsInsulinInsulin Infusion SystemsBlood GlucoseBlood Glucose Self-MonitoringContinuous Glucose MonitoringGlycated HemoglobinHumansRandomized Controlled Trials as TopicBlood GlucoseGlycated HemoglobinHypoglycemic AgentsInsulinclosed‐loop insulin deliveryglucose variabilityHbA1cmeta‐analysissensor‐augmented pumptime in rangetype 1 diabetes mellitus

Identifiers

PMID41527459
PMCPMC12900496

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.