{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:20:50Z","timestamp":1789863650165,"version":"4.0.1"},"reference-count":40,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Technology & Therapeutics"],"published-print":{"date-parts":[[2025,10]]},"abstract":"\n Objective:<\/jats:title>\n To evaluate longitudinal real-world outcomes in adults with type 1 diabetes initiating hybrid closed loop (HCL).<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Adults with type 1 diabetes, managed with an insulin pump and intermittently scanned continuous glucose monitoring with hemoglobin A1c (HbA1c) \u22658.5% (69 mmol\/mol), were started on HCL between August and December 2021 as part of the National Health Service England HCL pilot. We collected outcomes, including change in HbA1c, sensor glucometrics, Gold score (hypoglycemia awareness), diabetes distress score, acute event rates, and user opinion of HCL.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n In total, 420 HCL users across 30 diabetes centers in the United Kingdom were included (median age 40 [interquartile range or IQR 29\u201350] years, 68% female, 85% White British). Over a median follow-up of 12 months (IQR 8\u201328) (range 6\u201338 months), mean adjusted HbA1c reduced by 1.4% (95% confidence interval [CI] \u22121.5, \u22121.3;\n P<\/jats:italic>\n < 0.001) (16 mmol\/mol [95% CI \u221217, \u221214];\n P<\/jats:italic>\n < 0.001). Time in range (70\u2013180mg\/dL) increased from 33.7% to 60.4% (\n P<\/jats:italic>\n < 0.001). The proportion of individuals achieving HbA1c \u22647.5% (58 mmol\/mol) increased from 0% to 33.1% (\n P<\/jats:italic>\n < 0.001). Diabetes distress score reduced (\u22121.1; 95% CI \u22121.3, \u22121.0;\n P<\/jats:italic>\n < 0.001) and Gold score reduced (\u22120.4; 95% CI \u22120.5, \u22120.2;\n P<\/jats:italic>\n < 0.001). The percentage of individuals with impaired hypoglycemia awareness (Gold score \u22654) decreased (16.6% [baseline] vs. 9.2% [follow-up];\n P<\/jats:italic>\n < 0.001). Almost all participants stated that HCL had a positive impact on quality of life (94.5%; 361\/382). The number of hospital admissions was low.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Long-term real-world use of HCL is associated with sustained improvements in glycemic and person-reported outcomes in adults with type 1 diabetes and above-target HbA1c levels.<\/jats:p>\n <\/jats:sec>","DOI":"10.1089\/dia.2025.0165","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T12:11:02Z","timestamp":1748607062000},"page":"820-830","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Hybrid Closed-Loop Therapy in Adults with Type 1 Diabetes in England: Long-Term Outcomes from a Real-World Observational Study"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1713-3064","authenticated-orcid":false,"given":"Alexandros L.","family":"Liarakos","sequence":"first","affiliation":[{"name":"Department of Diabetes & Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom."},{"name":"Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas S.J.","family":"Crabtree","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom\u00e1s P.","family":"Griffin","sequence":"additional","affiliation":[{"name":"Leicester Diabetes Centre, University Hospitals of Leicester NHS Foundation Trust, Leicester, United Kingdom."},{"name":"Diabetes Research Centre, University of Leicester, Leicester, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6611-8245","authenticated-orcid":false,"given":"Sufyan","family":"Hussain","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Guy\u2019s and St. Thomas\u2019 NHS Foundation Trust, London, United Kingdom."},{"name":"Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King\u2019s College London, London, United Kingdom."},{"name":"Institute of Diabetes, Endocrinology and Obesity, King\u2019s Health Partners, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8288-3258","authenticated-orcid":false,"given":"Geraldine","family":"Gallen","sequence":"additional","affiliation":[{"name":"Kings College Hospital NHS Trust, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackie","family":"Elliott","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Northern General Hospital, Sheffield, United Kingdom."},{"name":"University of Sheffield, Sheffield, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niall","family":"Furlong","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, St Helens and Knowsley Hospitals NHS Trust, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parth","family":"Narendran","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Queen Elizabeth Hospital, Birmingham, United Kingdom."},{"name":"The Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hood","family":"Thabit","sequence":"additional","affiliation":[{"name":"Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom."},{"name":"Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lalantha","family":"Leelarathna","sequence":"additional","affiliation":[{"name":"Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom."},{"name":"Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark L.","family":"Evans","sequence":"additional","affiliation":[{"name":"Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom."},{"name":"Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Philbey","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iain","family":"Cranston","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shafie","family":"Kamaruddin","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, County Durham and Darlington NHS Foundation Trust, Durham, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zin Zin","family":"Htike","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn","family":"Sawyer","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, North Bristol NHS Trust, Bristol, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Curtis","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Dorset County Hospital, Dorchester, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesina","family":"Kirby","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Worthing Hospital, Worthing, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isy","family":"Douek","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Musgrove Park Hospital, Taunton, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali J.","family":"Chakera","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Saunders","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Mersey and West Lancashire NHS Teaching Hospitals Trust, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Bickerton","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Yeovil District Hospital, Yeovil, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zosanglura","family":"Bawlchhim","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Cedar Centre, Royal Surrey County Hospital, Guildford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Soar","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Nottingham City Hospital, Nottingham, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Wadham","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Ipswich Hospital, Ipswich, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, County Durham and Darlington NHS Foundation Trust, Darlington, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mindy","family":"Levitt","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Princess Royal Hospital, University Hospitals Sussex NHS Foundation Trust, Haywards Heath, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Weston","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Royal Liverpool University Hospital, Liverpool, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Partha","family":"Kar","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.J.","family":"Ryder","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alistair","family":"Lumb","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes Endocrinology and Metabolism, Oxford, United Kingdom."},{"name":"National Institute for Health and Care Research, Oxford Biomedical Research Centre, Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pratik","family":"Choudhary","sequence":"additional","affiliation":[{"name":"Leicester Diabetes Centre, University Hospitals of Leicester NHS Foundation Trust, Leicester, United Kingdom."},{"name":"Diabetes Research Centre, University of Leicester, Leicester, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma G.","family":"Wilmot","sequence":"additional","affiliation":[{"name":"Department of Diabetes & Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, 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Available from: https:\/\/www.nice.org.uk\/guidance\/ta943 [Last accessed: October8 2024]."},{"key":"e_1_3_6_15_2","first-page":"9","article-title":"Protocol for the diabetes technology network UK and Association of British Clinical Diabetologists\u2019 closed-loop insulin delivery audit programme","volume":"22","author":"Crabtree TSJ","year":"2022","unstructured":"Crabtree TSJ, , Griffin TP, , Lumb A, et al. Protocol for the diabetes technology network UK and Association of British Clinical Diabetologists\u2019 closed-loop insulin delivery audit programme. Br J Diabetes, 2022; 22:9\u201313.","journal-title":"Br J Diabetes"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1370\/afm.842"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.17.7.697"},{"key":"e_1_3_6_18_2","unstructured":"NHS Health Research Authority. Confidentiality Advisory Group. 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