Hybrid closed-­loop automated insulin delivery offers important psychological benefits for adults with type 1 diabetes, including improved diabetes-­specific positive wellbeing and reduced diabetes distress, Australian researchers say.

Their parallel-­group clinical trial involved 120 adults with T1D (mean age 44, 53% female) randomly allocated to 26 weeks of hybrid closed-­loop (HCL) or standard therapy consisting of insulin pump or multiple daily injections without real-­time continuous glucose monitoring.

Participants, who had lived with T1D for an average of 24 years, were recruited from seven public hospitals and one associated private clinic.

Findings published in BMJ Open Diabetes Research & Care [link here] showed the HCL group had significantly greater diabetes-specific positive wellbeing than the standard therapy group at 13 week follow-up, which was maintained at 26 weeks.

Also at 26 weeks, the HCL group had less diabetes distress and fear of hypoglycaemia, which included both worry about the negative consequences of hypoglycaemia and compensatory behaviours to “maintain high” glucose levels. They also perceived “unacceptably high glucose levels” less frequently than standard therapy patients.

The researchers said that diabetes distress was significantly reduced at 26 weeks but not at 13 weeks might reflect the time or experience needed with a new technology for improvement to occur, as well as inter-individual differences.

“Qualitative studies highlight that some people using HCL experience hassles, annoyance, and disruption of daily activities (eg, sleep, exercise) due to technical/connectivity problems and alarms. It is possible that HCL reduced many aspects of diabetes distress, but HCL hassles and trial conditions attenuated such benefits,” the authors wrote.

The researchers also said that HCL safeguards, such as warning alarms and insulin delivery modification to reduce severe hypoglycaemia risk, likely contributed to the reduction observed in worry and compensatory behaviours among participants.

However, the researchers found that being in the HCL group did not improve diabetes treatment satisfaction, diabetes-­specific quality of life, hypoglycaemia awareness or perceived frequency of unacceptably low glucose levels.

It also did not impact avoidance of situations of perceived hypoglycaemia risk.

The researchers said diabetes-­specific positive wellbeing had not been examined in previous HCL studies and had been an under-­researched topic generally.

“Given the relentless nature of diabetes self-­management, any improvement in diabetes-­specific positive wellbeing needs to be valued by healthcare professionals, industry, and policymakers. Diabetes-­specific positive wellbeing is worthy of further investigation in future diabetes technology trials,” they said.

The authors noted that their study did not include continuous glucose monitoring in their comparison, which has since become the standard of care in Australia.

The trial received in-kind support from Medtronic and Roche Diabetes Care.