Closed-loop therapy: recent advancements and potential predictors of glycemic outcomes

Abstract

Introduction: Hybrid closed-loop systems have become the standard of care for managing type 1 diabetes (T1D). Both clinical trials and real-world data have demonstrated that these systems improve glycemic control without increasing the risk of hypoglycemia, while also reducing the overall burden of T1D management. A systematic literature search was conducted using PubMed for studies including individuals with T1D that were published until the end of 2024. Areas covered: In this review, we summarize the safety and efficacy of currently available hybrid closed-loop systems, drawing from key clinical trials and real-world data analyses. We also highlight recent advancements in closed-loop systems, discuss their limitations and barriers to access, and explore future directions for automated insulin delivery. Finally, we explore potential predictors of outcomes for people with T1D to better understand why some individuals respond better to closed-loop systems than others. Expert opinion: Closed-loop systems are advancing rapidly, with a growing focus on enhancing automation through fully closed-loop systems to improve glycemic control and further reduce the burden of management. Identifying the predictors that influence how individuals respond to closed-loop therapy will enable these systems to be optimized. It is crucial to ensure widespread and equitable access to this advanced technology.