Closed-Loop Insulin Therapy Improves Glycemic Control in Adolescents and Young Adults: Outcomes from the International Diabetes Closed-Loop Trial
Open accessAbstract
Objective: To assess the efficacy and safety of closed-loop control (CLC) insulin delivery system in adolescents and young adults with type 1 diabetes. Research Design and Methods: Prespecified subanalysis of outcomes in adolescents and young adults aged 14–24 years old with type 1 diabetes in a previously published 6-month multicenter randomized trial. Participants were randomly assigned 2:1 to CLC (Tandem Control-IQ) or sensor augmented pump (SAP, various pumps+Dexcom G6 CGM) and followed for 6 months. Results: Mean age of the 63 participants was 17 years, median type 1 diabetes duration was 7 years, and mean baseline HbA1c was 8.1%. All 63 completed the trial. Time in range (TIR) increased by 13% with CLC versus decreasing by 1% with SAP (adjusted treatment group difference = +13% [+3.1 h/day]; 95% confidence interval [CI] 9–16, P < 0.001), which largely reflected a reduction in time >180 mg/dL (adjusted difference −12% [−2.9 h/day], P < 0.001). Time <70 mg/dL decreased by 1.6% with CLC versus 0.3% with SAP (adjusted difference −0.7% [−10 min/day], 95% CI −1.0% to −0.2%, P = 0.002). CLC use averaged 89% of the time for 6 months. The mean adjusted difference in HbA1c after 6 months was 0.30% in CLC versus SAP (95% CI −0.67 to +0.08, P = 0.13). There was one diabetic ketoacidosis episode in the CLC group. Conclusions: CLC use for 6 months was substantial and associated with improved TIR and reduced hypoglycemia in adolescents and young adults with type 1 diabetes. Thus, CLC has the potential to improve glycemic outcomes in this challenging age group. The clinical trial was registered with ClinicalTrials.gov (NCT03563313).
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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 [34]
The Results (page not provided) show that closed-loop therapy increased time in range and reduced time below 70 mg/dL in adolescents and young adults. HbA1c fell in the treatment group, but the between-group difference was not statistically significant; the Conclusions explicitly note this limitation. Citation 34 is attached to the adolescent claim, not the separate claims about generation 1 systems in children or outcomes in adults. (LLM, conf=0.90)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Continuous glucose monitoring and intensive treatment of type 1 diabetes
(2008) · New England Journal of Medicine · doi:10.1056/nejmoa0805017 · Cited by 1,559 · see citing works
Six-Month Randomized, Multicenter Trial of Closed-Loop Control in Type 1 Diabetes
Brown, S. A., Kovatchev, B. P., Raghinaru, D., Lum, J. W., Buckingham, B. A., Kudva, Y. C., Laffel, L. M., Levy, C. J., Pinsker, J. E., Wadwa, R. P., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1907863 · Cited by 1,030 · see citing works
Self-citationThe Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group (2016) · Diabetes Care · doi:10.2337/dc15-1990 · Cited by 712 · see citing works
Garg, S. K., Weinzimer, S. A., Tamborlane, W. V., Buckingham, B. A., Bode, B. W., Bailey, T. S., Brazg, R. L., Ilany, J., Slover, R. H., Anderson, S. M., et al. (2017) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2016.0421 · Cited by 585 · cited 2× · see citing works
“21 Maximizing the proportion of time in automated insulin delivery mode is critical if closed-loop systems are to deliver on their promise of improving glycemic outcomes and less-ening patient burden.”
Self-citationTauschmann, M., Thabit, H., Bally, L., Allen, J. M., Hartnell, S., Wilinska, M. E., Ruan, Y., Sibayan, J., Kollman, C., Cheng, P., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)31947-0 · Cited by 440 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 18
- [1]1. Foster NC, Beck RW, Miller KM, et al. : State of type 1 diabetes management and outcomes from the T1D Exchange in 2016–2018. Diabetes Technol Ther 2019;21:66–72 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [2]2. American Diabetes Association: 13. Children and adolescents: standards of medical care in diabetes-2020. Diabetes Care 2020;43:S163–S182 [DOI] [PubMed] [Google Scholar]
- [3]3. Hermann JM, Miller KM, Hofer SE, et al. : The transatlantic HbA1c gap; differences in glycaemic control across the lifespan between people included in the US T1D Exchange Registry and those included in the German/Austrian DPV registry. Diabet Med 2020;37:848–855 [DOI] [PubMed] [Google Scholar]
- [5]5. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study Research Group: Mortality in type 1 diabetes in the DCCT/EDIC versus the general population. Diabetes Care 2016;39:1378–138327411699 [Google Scholar]
- [6]6. Diabetes Control and Complications Trial Research Group; Nathan DM, Genuth S, Lachin J, et al. : the effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977–986 [DOI] [PubMed] [Google Scholar]
- [7]7. Ekhlaspour L, Forlenza GP, Chernavvsky D, et al. : Closed loop control in adolescents and children during winter sports: use of the Tandem Control-IQ AP system. Pediatr Diabetes 2019;20:759–768 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [8]8. Ly TT, Buckingham BA, DeSalvo DJ, et al. : Day-and-night closed-loop control using the unified safety system in adolescents with type 1 diabetes at camp. Diabetes Care 2016;39:e106–e107 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [9]9. Ly TT, Keenan DB, Roy A, Han J, et al. : Automated overnight closed-loop control using a proportional-integral-derivative algorithm with insulin feedback in children and adolescents with type 1 diabetes at diabetes camp. Diabetes Technol Ther 2016;18:377–384 [DOI] [PubMed] [Google Scholar]
- [10]10. Phillip M, Battelino T, Atlas E, et al. : nocturnal glucose control with an artificial pancreas at a diabetes camp. N Engl J Med 2013;368:824–833 [DOI] [PubMed] [Google Scholar]
- [11]11. Russell SJ, Hillard MA, Balliro C, et al. : Day and night glycaemic control with a bionic pancreas versus conventional insulin pump therapy in preadolescent children with type 1 diabetes: a randomised crossover trial. Lancet Diabetes Endocrinol 2016;4:233–243 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [12]12. Duffus SH, Ta'ani ZA, Slaughter JC, et al. : Increased proportion of time in hybrid closed-loop “Auto Mode” is associated with improved glycaemic control for adolescent and young patients with adult type 1 diabetes using the MiniMed 670G insulin pump. Diabetes Obes Metab 2020;22:688–693 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [13]13. Berget C, Messer LH, Vigers T, et al. : Six months of hybrid closed loop in the real-world: an evaluation of children and young adults using the 670G system. Pediatr Diabetes 2020;21:310–318 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [14]14. Messer LH, Berget C, Vigers T, et al. : Real world hybrid closed-loop discontinuation: predictors and perceptions of youth discontinuing the 670G system in the first 6 months. Pediatr Diabetes 2020;21:319–327 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [16]16. Chernavvsky DR, DeBoer MD, Keith-Hynes P, et al. : Use of an artificial pancreas among adolescents for a missed snack bolus and an underestimated meal bolus. Pediatr Diabetes 2016;17:28–35 [DOI] [PubMed] [Google Scholar]
- [17]17. Bangor A, Kortum P, Miller J: Determining what individual SUS scores mean: adding an adjective rating scale. J Usab Stud 2009;4:114–123 [Google Scholar]
- [19]19. Sherr JL: Closing the loop on managing youth with type 1 diabetes: children are not just small adults. Diabetes Care 2018;41:1572–1578 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [22]22. Akturk HK, Giordano D, Champakanath A, et al. : Long-term real-life glycaemic outcomes with a hybrid closed-loop system compared with sensor-augmented pump therapy in patients with type 1 diabetes. Diabetes Obes Metab 2020;22:583–589 [DOI] [PubMed] [Google Scholar]
- [23]23. Messer LH, Forlenza GP, Sherr JL, et al. : Optimizing hybrid closed-loop therapy in adolescents and emerging adults using the MiniMed 670G System. Diabetes Care 2018;41:789–796 [DOI] [PMC free article] [PubMed] [Google Scholar] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article.
Cited by
Sorted by citations
9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Bajaj, M., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s009 · Cited by 728 · see citing works
Self-citationPhillip, M., Nimri, R., Bergenstal, R. M., Barnard-Kelly, K., Danne, T., Hovorka, R., Kovatchev, B. P., Messer, L. H., Parkin, C. G., Ambler-Osborn, L., et al. (2023) · Endocrine Reviews · doi:10.1210/endrev/bnac022 · Cited by 443 · see citing works
Self-citationBergenstal, R. M., Nimri, R., Beck, R. W., Criego, A., Laffel, L., Schatz, D., Battelino, T., Danne, T., Weinzimer, S. A., Sibayan, J., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(20)32514-9 · Cited by 344 · see citing works
Self-citationReal-World Performance of the MiniMed™ 780G System: First Report of Outcomes from 4120 Users
Silva, J. D., Lepore, G., Battelino, T., Arrieta, A., Castañeda, J., Grossman, B., Shin, J., & Cohen, O. (2022) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2021.0203 · Cited by 229 · see citing works
14. Children and Adolescents: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s014 · Cited by 173 · see citing works
Self-citationSherr, J. L., Heinemann, L., Fleming, G. A., Bergenstal, R. M., Bruttomesso, D., Hanaire, H., Holl, R. W., Petrie, J. R., Peters, A. L., & Evans, M. (2022) · Diabetes Care · doi:10.2337/dci22-0018 · Cited by 136 · see citing works
Zeng, B., Gao, L., Yang, Q., Jia, H., & Sun, F. (2023) · Diabetes Care · doi:10.2337/dc23-0504 · Cited by 100 · see citing works
Blood glucose monitoring devices: current considerations
Sly, B., & Taylor, J. (2023) · Australian Prescriber · doi:10.18773/austprescr.2023.013 · Cited by 11 · see citing works
- Authors
- Isganaitis, E., Raghinaru, D., Ambler-Osborn, L., Pinsker, J. E., Buckingham, B. A., Wadwa, R. P., Ekhlaspour, L., Kudva, Y. C., Levy, C. J., Forlenza, G. P., Beck, R. W., Kollman, C., Lum, J. W., Brown, S. A., Laffel, L. M., for the iDCL Trial Research Group, Kovatchev, B., Anderson, S., Emory, E., Voelmle, M., Conshafter, K., Morris, K., Oliveri, M., Gondor-Fredrick, L., Mitchell, H., Calvo, K., Wakeman, C., Breton, M., Flint, E., Kim, K., Roethke, L., Church, M. M., Andre, C., Piper, M., Lam, D., O'Malley, G., Levister, C., Ogyaadu, S., Lovett, J., Simha, V., Dadlani, V., McCrady-Spitzer, S., Reid, C., Kumari, K., Forlenza, G., Alonso, G. T., Slover, R., Jost, E., Messer, L., Berget, C., Towers, L., Rossick-Solis, A., Jacobson, T., Town, M., Tabatabai, I., Keller, J., Salas, E., Doyle, F., Dassau, E., Passman, S., Campos, T., Murphy, C., Patibandla, N., Borgman, S., Arreaza-Rubín, G., Green, N., Kovatchev, B., Brown, S., Anderson, S., Breton, M., Laffel, L., Pinsker, J., Levy, C., Wadwa, R. P., Buckingham, B., Doyle, F., Renard, E., Cobelli, C., Reznik, Y., Arreaza-Rubín, G., Lum, J., Beck, R., Janicek, R., Gabrielson, D., Belle, S. H., Castle, J., Green, J., Legault, L., Willi, S. M., Wysham, C., & Eggerman, T.
- Affiliations
- Joslin Diabetes Center (US)
- Jaeb Center for Health Research (US)
- Sansum Diabetes Research Institute (US)
- Pediatric Endocrinology and Diabetes, Stanford Children's Health, Stanford, California, USA.
- Stanford Health Care (US)
- Mayo Clinic (US)
- Department of Medicine, Endocrinology, Diabetes and Bone Diseases, Mount Sinai Diabetes Center, New York, New York, USA.
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
- Jaeb Center for Health Research, Tampa, Florida, USA.
- Endocrinology and Metabolism Division, Department of Medicine, Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA.
- Research Division, Department of Pediatrics, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA.
- ORCID
- Isganaitis, Elvira
- Pinsker, Jordan E.
- Ekhlaspour, Laya
- Kudva, Yogish C.
- Kollman, Craig
- Oliveri, Mary
- Church, Mei Mei
- Andre, Camille
- Lam, David
- Simha, Vinaya
- McCrady-Spitzer, Shelly
- Kumari, Kanchan
- Jost, Emily
- Messer, Laurel
- Berget, Cari
- Tabatabai, Ideen
- Dassau, Eyal
- Cobelli, Claudio
- Reznik, Yves
- Castle, Jessica
- Green, Jennifer
- Legault, Laurent
- Willi, Steven M.
- Wysham, Carol
- Venue
- Diabetes Technology & Therapeutics
- Publisher
- SAGE Publications
- Published
- 2021-04-20
- Volume
- 23
- Issue
- 5
- Pages
- 342-349
- ISSN
- 1520-9156 (ISSN-L)
- 1557-8593
- PMC
- PMC8080922
- OpenAlex
- W3099316592
- Cited by
- 115
- References
- 5
- Citations by year
- 2026: 13 · 2025: 22 · 2024: 25 · 2023: 23 · 2022: 19 · 2021: 13
- FWCI
- 10.37
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Technology & Therapeutics (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK057521, U24DK123768, UC4DK108483, P60DK020541, K23DK121942, P30DK036836, P30DK020541)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R21HD091974)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- artificial pancreas, type 1 diabetes, adolescents and young adults, glycemic control, time in range, sensor-augmented pump, continuous glucose monitoring, HbA1c, hypoglycemia, diabetic ketoacidosis
- MeSH terms
- Glycemic Control, Adolescent, Adult, Blood Glucose, Diabetes Mellitus, Type 1, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
