Glycaemic control and variability with different commercially available hybrid closed loop systems in people with type 1 diabetes: A systematic review and meta-analysis of randomized controlled trials

Aims: To provide an updated analysis of the performance of different hybrid closed loop (HCL) systems in randomised controlled trials (RCTs) on subjects with type 1 diabetes. Materials and methods: We conducted a systematic review with meta-analysis. We searched four online databases and performed hand-searching of conference proceedings to find studies from inception to 18 April 2025. We included RCTs enrolling subjects with type 1 diabetes, evaluating commercial HCL systems against other insulin therapy regimens, with a duration of intervention ≥2 weeks, and reporting time in range (TIR) as an outcome. Studies involving pregnant women were excluded. Results: A total of 37 studies evaluating seven different HCL systems (CamAPS Fx, Control IQ, DBLG1, iLet BP, MiniMed 670G, MiniMed 780G, and Omnipod 5) were included. In studies with a mean age < 18 years, mean TIR was 64.1% (95% CI: 61-67.2), ranging from 59.3% (95% CI: 49.6-69.1) with MiniMed 780G to 68% (95% CI: 65.8-70.3) with Control IQ, and end-of-study HbA1c was 7.4% (95% CI: 7-7.7), ranging from 6.7% (95% CI: 6.6-6.9) with CamAPS Fx to 7.9% (95% CI: 6.9-9) with MiniMed 780G. In studies with a mean age ≥ 18 years, mean TIR was 70.8% (95% CI: 68.6-73), ranging from 63.1% (95% CI: 59.4-66.8) with Omnipod 5 to 74.4% (95% CI: 69.7-79.1) with MiniMed 780G, and end-of-study HbA1c was 7.1% (95% CI: 7-7.3), ranging from 7.0% (95% CI: 6.9-7.1) with Control IQ to 7.2% (95% CI: 7-7.5) with MiniMed 670G. Conclusions: In RCTs, commercial HCL systems show different achievements of CGM metrics and HbA1c in people with type 1 diabetes.