Meta‐analysis ranks efficacy of different HCL systems for T1D

A network meta-analysis shows that hybrid closed loop (HCL) systems have a hierarchy of efficacy in achieving glycaemic control among individuals with type 1 diabetes (T1D).

“[O]ur analysis reveals that commercial HCL systems are not equally efficacious in achieving glycaemic control, and that differences may exist in specific subgroups of patients,” said the researchers.

A total of 28 studies (n=2,446) were included. The five HCL systems evaluated were Minimed 670G, Minimed 780G, Control‐IQ, CamAPS Fx, Diabeloop Generation 1 (DBLG‐1). [Diabetes Metab Res Rev 2024;40:e3842]

Primary outcome: TIR

All HCL systems significantly increased time in range (TIR) vs SIT*, with Minimed 780G showing the largest improvement (mean difference [MD], 21.6 percent [H**]). Minimed 780G showed superiority over Control IQ (MD, 5.1 percent [L**]), Minimed 670G (MD, 7.48 percent [M**]), CamAPS Fx (MD, 8.94 percent [L]), and DBLG1 (MD, 10.69 percent [L]).

“[The MDs are] of interest, as international consensus identifies a difference of ≥3 percent in mean TIR (absolute percentage points) to be clinically meaningful,” the researchers said.

TBR, TAR, AEs

Time below range (TBR) dropped significantly with all HCL systems vs SIT. The largest reductions were with DBLG1 (MD, -3.69 percent [H]) and Minimed 670G (MD, -2.9 percent [M]).

DBLG1 outranked Control IQ (MD, -1.19 percent [L]) and CamAPS Fx (MD, -1.68 percent [M]). “This is not surprising [given] that the DBLG1 algorithm allows a higher hypoglycaemia threshold to be set for insulin delivery and further recommends calibrated preventive sugaring when hypoglycaemia is predicted despite basal rate reduction. These two unique features may be responsible for enhanced protection against hypoglycaemia,” the investigators said.

Time above range (TAR) also dropped significantly with all HCL systems vs SIT, with Minimed 780G (MD, -18.82 percent [H]) and Control IQ (MD, -14.28 percent [L]) achieving the largest reductions. Minimed 780G trumped all HCL systems except Control IQ in reducing TAR (MD, 4.54 percent [L]).

The risk of severe hypoglycaemia and diabetic ketoacidosis did not significantly differ between HCL systems and other types of SC intensive insulin therapy. Of the five hard events reported, only one was from the HCL group. All serious adverse events were unrelated to treatment.

Subgroup analysis

TIR improvement was greater with Control‐IQ, CamAPS Fx, and DBLG1 vs SIT among individuals aged <18 years and those with disease duration <10 years.

According to the researchers, the findings among younger individuals were noteworthy. “While younger participants, irrespective of treatment, achieved lower TIR levels at study end than their adult counterparts, HCL systems, particularly those with predictive algorithms, were shown to reduce this gap unlike SIT or other CGM***‐enhanced technologies.”

“However, [except for] a single study evaluating Minimed 670G, all studies conducted in patients with mean age <18 years also had mean diabetes duration <10 years. Therefore, the encouraging results in younger participants might simply reflect the greater efficacy of certain systems in patients with short‐standing diabetes who are possibly more prone to comply with algorithm‐driven insulin delivery,” they continued.

Tailors decision-making

“[Taken together,] our analysis may provide further insights to support patient‐tailored decision-making,” the researchers said. For instance, clinicians may lean towards Minimed 780G and Control‐IQ as first choices for achieving TIR goals in certain patient subgroups, while DBLG1 may be considered when TBR reduction is a priority.