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Advanced hybrid closed loop therapy versus conventional treatment in adults with type 1 diabetes (ADAPT): a randomised controlled study

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Choudhary, Pratik, Kolassa, Ralf, Keuthage, Winfried, Kroeger, Jens, Thivolet, Charles, Evans, Mark, Ré, Roseline, de Portu, Simona +6 more·2022·The Lancet Diabetes & Endocrinology
DOI 10.1016/s2213-8587(22)00212-1
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Abstract

BACKGROUND Adults with type 1 diabetes who are treated with multiple daily injections of insulin plus intermittently scanned continuous glucose monitoring (isCGM) can have suboptimal glucose control. We aimed to assess the efficacy of an advanced hybrid closed loop (AHCL) system compared with such therapy in this population. METHODS The Advanced Hybrid Closed Loop Study in Adult Population with Type 1 Diabetes (ADAPT) trial is a prospective, multicentre, open-label, randomised controlled trial that involved 14 centres in three European countries (France, Germany, and the UK). We enrolled patients who were at least 18 years of age, had a type 1 diabetes duration of at least 2 years, HbA1c of at least 8% (64 mmol/mol), and were using multiple daily injections of insulin plus isCGM (cohort A) or real time continuous glucose monitoring (cohort B) for at least 3 months. Here, only results for cohort A are reported. Participants were randomly allocated 1:1 to AHCL therapy or continuation of multiple daily injections of insulin plus continuous glucose monitoring for 6 months with an investigator-blinded block randomisation procedure. Participants and treating clinicians could not be masked to the arm assignment. The primary endpoint was the between-group difference in mean HbA1c change from baseline to 6 months in the intention-to-treat population using AHCL therapy and those using multiple daily injections of insulin plus isCGM. The primary endpoint was analysed using a repeated measures random-effects model with the study arm and period as factors. Safety endpoints included the number of device deficiencies, severe hypoglycaemic events, diabetic ketoacidosis, and serious adverse events. This study is registered with ClinicalTrials.gov, NCT04235504. FINDINGS Between July 13, 2020, and March 12, 2021, 105 people were screened and 82 randomly assigned to treatment (41 in each arm). At 6 months, mean HbA1c had decreased by 1·54% (SD 0·73), from 9·00% to 7·32% in the AHCL group and 0·20% (0·80) in the multiple daily injections of insulin plus isCGM from 9·07% to 8·91% (model-based difference -1·42%, 95% CI -1·74 to -1·10; p<0·0001). No diabetic ketoacidosis, severe hypoglycaemia, or serious adverse events related to study devices occurred in either group; two severe hypoglycaemic events occurred in the run-in phase. 15 device-related non-serious adverse events occurred in the AHCL group, compared with three in the multiple daily injections of insulin plus isCGM group. Two serious adverse events occurred (one in each group), these were breast cancer (in one patient in the AHCL group) and intravitreous haemorrhage (in one patient in the multiple daily injections of insulin plus isCGM group). INTERPRETATION In people with type 1 diabetes using multiple daily injections of insulin plus isCGM and with HbA1c of at least 8%, the use of AHCL confers benefits in terms of glycaemic control beyond those that can be achieved with multiple daily injections of insulin plus isCGM. These data support wider access to AHCL in people with type 1 diabetes not at target glucose levels. FUNDING Medtronic International Trading Sàrl.

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Crossref · 10.1016/s2213-8587(22)00212-1

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  • The most substantial HbA1c reduction among automated insulin delivery studies was observed with closed-loop systems compared to MDI + CGM (−1.0%, P<0.001) in Choudhary et al. (2022).

    “The most substantial HbA1c reduction was observed with closed-loop systems compared to MDI + CGM (−1.0 %, P-value<0.001) in the study by Choudhary et al. (2022).”

    From Effectiveness of continuous glucose monitoring systems on glycemic control in adults with type 1 diabetes: A systematic review and meta-analysis (2025) · cites this paper as Choudhary et al. (2022)

  • Studies evaluating closed-loop systems (Choudhary et al., 2022; Matejko et al., 2022) reported significant improvements in quality of life measures.

    “the studies evaluating closed-loop systems (Choudhary et al., 2022, Matejko et al., 2022) reported significant improvements in quality of life measures.”

    From Effectiveness of continuous glucose monitoring systems on glycemic control in adults with type 1 diabetes: A systematic review and meta-analysis (2025) · cites this paper as Choudhary et al., 2022

  • Both generation 1 low-glucose-suspend and generation 2 hybrid closed-loop systems improve glycated haemoglobin concentrations, time in target range, and time below target range in children, adolescents, and adults.

    “Both generation 1 low-glucose-suspend33 and generation 2 hybrid closed-loop systems improve glycated haemoglobin concentrations, the time in target range and the time below target range in children, adolescents34 and adults.35-37”

    From Blood glucose monitoring devices: current considerations (2023) · cites this paper as [36]

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Authors
Choudhary, P., Kolassa, R., Keuthage, W., Kroeger, J., Thivolet, C., Evans, M., Ré, R., de Portu, S., Vorrink, L., Shin, J., Habteab, A., Castañeda, J., da Silva, J., & Cohen, O.
Affiliations
  • University of Leicester (GB)
  • Hospices Civils de Lyon (FR)
  • University of Cambridge (GB)
  • Medtronic (Switzerland) (CH)
  • Medtronic (United States) (US)
  • Medtronic (Netherlands) (NL)
Corresponding author
Cohen, Ohad
ORCID
Venue
The Lancet Diabetes & Endocrinology
Publisher
Elsevier BV
Published
2022-10
Volume
10
Issue
10
Pages
720-731
ISSN
2213-8587 (ISSN-L)
DOI
10.1016/s2213-8587(22)00212-1
OpenAlex
W4294215685
Semantic Scholar
04dc98442e2375f436f290b55f4eb6ad236201dd
Cited by
204
References
41
Citations by year
2026: 44 · 2025: 50 · 2024: 54 · 2023: 55 · 2022: 1
FWCI
29.63
Type
journal article
Language
en
Update notices
erratum (2023-07-01)
Open access
Licence
Locations
  • The Lancet Diabetes & Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
  • Figshare (submittedVersion, cc-by)
Funders
  • Medtronic Inc
  • King's College London
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
type 1 diabetes, multiple daily insulin injections, real-time continuous glucose monitoring, HbA1c, glycemic control, hypoglycemia, diabetic ketoacidosis, device safety, adults with type 1 diabetes, insulin pump therapy, artificial pancreas, ADAPT trial, serious adverse events
MeSH terms
Adult, Blood Glucose, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, Prospective Studies, Blood Glucose Self-Monitoring, Diabetic Ketoacidosis, Treatment Outcome

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