Hybrid closed-loop pumps lowered HbA1c in UK children with poor control

Design

Retrospective multicentre observational cohort

Population

220 children and young people with type 1 diabetes and HbA1c at or above 69 mmol/mol, 13 UK units

Primary outcome

Change in HbA1c after hybrid closed-loop initiation

Effect

82.5 to 72.8 mmol/mol at 3 months and 69.3 at 12 months (P < 0.001)

This retrospective cohort followed 220 children and young people aged 19 or under from 13 paediatric diabetes units in England. All had type 1 diabetes for more than a year and an HbA1c of at least 69 mmol/mol when they started hybrid closed-loop pump therapy.

Mean HbA1c fell from 82.5 mmol/mol to 72.8 within three months and was 69.3 at 12 months (P below 0.001). The fall was greatest in those with a baseline above 100 mmol/mol and in those moving from multiple daily injections. Results were similar across pump systems, and diabetes-related hospital admissions fell overall.

There was no control group, and children selected for pumps are often those with engaged families and supported teams. Regression to the mean is also likely when starting from an extreme value. Cost and the training and supervision these systems need limit use in many Indian settings.

• Consider referral for advanced insulin delivery in children whose control remains poor despite good support.
• Address adherence, injection technique, diet and psychosocial barriers alongside any technology.
• Plan training and follow-up before starting a pump; the benefit in this study came with team support.
• Do not expect technology alone to fix poor control.

Why it matters

It suggests children with the worst control, not only the best-supported, may benefit from closed-loop systems.

Don't overread it

This was a retrospective cohort without controls, so the fall cannot be attributed to the pump alone.

The statistics, in plain English

A mean fall of about 13 mmol/mol is large clinically, but with no comparison group some fall would be expected anyway in children starting from very high values, because the extremes tend to move towards the average on re-test.

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