Better TIR, HbA1c, and less hypoglycemia in closed-loop insulin system in patients with type 1 diabetes: a meta-analysis
Open accessAbstract
The study aimed to evaluate the effectiveness and safety of long-term use of closed-loop insulin system (CLS) in non-pregnant patients with type 1 diabetes mellitus (T1DM) using systematic review and meta-analysis. A literature search was performed using MEDLINE, EMBASE, and the Cochrane Library. Randomized controlled trials (RCTs) on long-term use (not less than 8 weeks) of CLS in patients with T1DM were selected. Meta-analysis was performed with RevMan V.5.3.5 to compare CLS with controls (continuous subcutaneous insulin infusion with blinded continuous glucose monitoring or unblinded sensor-augmented pump therapy or multiple daily injections or predictive low-glucose suspend system) in adults and children with type 1 diabetes. Research quality evaluation was conducted using the Cochrane risk of bias tool. Eleven RCTs (817 patients) that satisfied the eligibility criteria were included in the meta-analysis. Compared with controls, the CLS group had a favorable effect on the proportion of time with sensor glucose level in 3.9–10 mmol/L (10.32%, 8.70% to 11.95%), above 10 mmol/L (−8.89%, −10.57% to −7.22%), or below 3.9 mmol/L (−1.09%, −1.54% to −0.64%) over 24 hours. The CLS group also had lower glycated hemoglobin levels (−0.30%, −0.41% to −0.19%), and glucose variability, coefficient of variation of glucose, and SD were lower by 1.41 (−2.38 to −0.44, p=0.004) and 6.37 mg/dL (−9.19 mg/dL to −3.55 mg/dL, p<0.00001). There were no significant differences between the CLS and the control group in terms of daily insulin dose, quality of life assessment, and satisfaction with diabetes treatment. CLS is a better solution than control treatment in optimizing blood glucose management in patients with T1DM. CLS could become a common means of treating T1DM in clinical practice.
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Closed-loop systems demonstrate greater improvement in TIR levels compared with usual care.
“and that closed‐loop systems demonstrate greater improvement in TIR levels compared with usual care [36].”
From Effectiveness of Wearable Devices for Diabetes Management: An Overview of Systematic Reviews and Meta‐Analyses (2026) · cites this paper as [36]
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Cites
International Diabetes Federation 2017
Carracher, A. M., Marathe, P. H., & Close, K. L. (2018) · Journal of Diabetes · doi:10.1111/1753-0407.12644 · Cited by 13,369 · see citing works
Wan, X., Wang, W., Liu, J., & Tong, T. (2014) · BMC Medical Research Methodology · doi:10.1186/1471-2288-14-135 · Cited by 11,735 · see citing works
Cochrane Handbook for Systematic Reviews of Interventions
Tarsilla, M. (2010) · Journal of MultiDisciplinary Evaluation · doi:10.56645/jmde.v6i14.284 · Cited by 5,228 · see citing works
Luo, D., Wan, X., Liu, J., & Tong, T. (2018) · Statistical Methods in Medical Research · doi:10.1177/0962280216669183 · Cited by 4,066 · cited 1× · see citing works
“There were no significant differences between the CLS and the control group in terms of daily insulin dose, quality of life assessment, and satisfaction with diabetes treatment (online supplemental appendices 10 and 11).”
Battelino, T., Danne, T., Bergenstal, R. M., Amiel, S. A., Beck, R., Biester, T., Bosi, E., Buckingham, B. A., Cefalu, W. T., Close, K. L., et al. (2019) · Diabetes Care · doi:10.2337/dci19-0028 · Cited by 4,032 · cited 1× · see citing works
“…for glucose levels to fall in the target range according to the recommendations of the guidelines for T1DM, starting from 70 mg/dL to 180 mg/ dL. 22 23 Besides being reflective of the day- to-day experience of individuals with diabetes, 24 TIR can be used to predict the risk of future diabetic…”
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
Bonds, D. E., Miller, M. E., Bergenstal, R. M., Buse, J. B., Byington, R. P., Cutler, J. A., Dudl, R. J., Ismail-Beigi, F., Kimel, A. R., Hoogwerf, B., et al. (2010) · BMJ · doi:10.1136/bmj.b4909 · Cited by 933 · cited 1× · see citing works
“39 It is reasonable to speculate that this also applies to patients with T1DM.”
6. Glycemic Targets: <i>Standards of Medical Care in Diabetes—2021</i>
American Diabetes Association (2021) · Diabetes Care · doi:10.2337/dc21-s006 · Cited by 847 · see citing works
Validation of Time in Range as an Outcome Measure for Diabetes Clinical Trials
Beck, R. W., Bergenstal, R. M., Riddlesworth, T. D., Kollman, C., Li, Z., Brown, A. S., & Close, K. L. (2019) · Diabetes Care · doi:10.2337/dc18-1444 · Cited by 793 · see citing works
(2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.193 · Cited by 653 · see citing works
Lu, J., Ma, X., Zhou, J., Zhang, L., Mo, Y., Ying, L., Lu, W., Zhu, W., Bao, Y., Vigersky, R. A., et al. (2018) · Diabetes Care · doi:10.2337/dc18-1131 · Cited by 517 · see citing works
The relationships between time in range, hyperglycemia metrics, and HbA1c
Beck, R. W., Bergenstal, R. M., Cheng, P., Kollman, C., Carlson, A. L., Johnson, M. L., & Rodbard, D. (2019) · Journal of Diabetes Science and Technology · doi:10.1177/1932296818822496 · Cited by 479 · see citing works
Weisman, A., Bai, J.-W., Cardinez, M., Kramer, C. K., & Perkins, B. A. (2017) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30167-5 · Cited by 463 · see citing works
A Randomized Trial of Closed-Loop Control in Children with Type 1 Diabetes
Breton, M. D., Kanapka, L. G., Beck, R. W., Ekhlaspour, L., Forlenza, G. P., Cengiz, E., Schoelwer, M., Ruedy, K. J., Jost, E., Carria, L., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2004736 · Cited by 455 · see citing works
Home Use of an Artificial Beta Cell in Type 1 Diabetes
Thabit, H., Tauschmann, M., Allen, J. M., Leelarathna, L., Hartnell, S., Wilinska, M. E., Acerini, C. L., Dellweg, S., Benesch, C., Heinemann, L., et al. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1509351 · Cited by 450 · see citing works
Declining Incidence of Nephropathy in Insulin-Dependent Diabetes Mellitus
Bojestig, M., Arnqvist, H. J., Hermansson, G., Karlberg, B. E., & Ludvigsson, J. (1994) · New England Journal of Medicine · doi:10.1056/nejm199401063300103 · Cited by 448 · see citing works
Tauschmann, 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
Bekiari, E., Kitsios, K., Thabit, H., Tauschmann, M., Athanasiadou, E., Karagiannis, T., Haidich, A.-B., Hovorka, R., & Tsapas, A. (2018) · BMJ · doi:10.1136/bmj.k1310 · Cited by 437 · see citing works
Benhamou, P.-Y., Franc, S., Reznik, Y., Thivolet, C., Schaepelynck, P., Renard, E., Guerci, B., Chaillous, L., Lukas-Croisier, C., Jeandidier, N., et al. (2019) · The Lancet Digital Health · doi:10.1016/s2589-7500(19)30003-2 · Cited by 217 · see citing works
Kilpatrick, E. S., Rigby, A. S., Goode, K. M., & Atkin, S. L. (2007) · Diabetologia · doi:10.1007/s00125-007-0820-z · Cited by 208 · see citing works
Kropff, J., Favero, S. D., Place, J., Toffanin, C., VISENTIN, R., Monaro, M., Messori, M., Palma, F. D., Lanzola, G., Farret, A., et al. (2015) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(15)00335-6 · Cited by 201 · see citing works
Artificial Pancreas Device Systems for the Closed-Loop Control of Type 1 Diabetes
Trevitt, S., Simpson, S., & Wood, A. L. (2015) · Journal of Diabetes Science and Technology · doi:10.1177/1932296815617968 · Cited by 175 · see citing works
Hermanides, J., Nørgaard, K., Bruttomesso, D., Mathieu, C., Frid, A. H., Dayan, C. M., Diem, P., Fermon, C., Wentholt, I. M. E., Hoekstra, J. B. L., et al. (2011) · Diabetic Medicine · doi:10.1111/j.1464-5491.2011.03256.x · Cited by 169 · see citing works
Nordwall, M., Abrahamsson, M., Dhir, M., Fredrikson, M., Ludvigsson, J., & Arnqvist, H. J. (2015) · Diabetes Care · doi:10.2337/dc14-1203 · Cited by 161 · see citing works
McAuley, S. A., Lee, M. H., Paldus, B., Vogrin, S., de Bock, M. I., Abraham, M. B., Bach, L. A., Burt, M. G., Cohen, N. D., Colman, P. G., et al. (2020) · Diabetes Care · doi:10.2337/dc20-1447 · Cited by 158 · see citing works
Bally, L., Thabit, H., Kojzar, H., Mader, J. K., Qerimi-Hyseni, J., Hartnell, S., Tauschmann, M., Allen, J. M., Wilinska, M. E., Pieber, T. R., et al. (2017) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30001-3 · Cited by 149 · see citing works
Cox, D. J., Kovatchev, B. P., Julian, D. M., Gonder-Frederick, L. A., Polonsky, W. H., Schlundt, D. G., & Clarke, W. L. (1994) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.79.6.7989471 · Cited by 137 · see citing works
Does industrial agglomeration facilitate environmental performance: New evidence from urban China?
Wang, Y., & Wang, J. (2019) · Journal of Environmental Management · doi:10.1016/j.jenvman.2019.07.015 · Cited by 133 · see citing works
Maser, R. E., Wolfson, S. K., Ellis, D., Stein, E. A., Drash, A. L., Becker, D. J., Dorman, J. S., & Orchard, T. J. (1991) · Arteriosclerosis and Thrombosis: A Journal of Vascular Biology · doi:10.1161/01.atv.11.4.958 · Cited by 98 · see citing works
Realistic Expectations and Practical Use of Continuous Glucose Monitoring for the Endocrinologist
Hirsch, I. B. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-2625 · Cited by 93 · see citing works
Runge, A. S., Kennedy, L., Brown, A. S., Dove, A. E., Levine, B. J., Koontz, S. P., Iyengar, V. S., Odeh, S. A., Close, K. L., Hirsch, I. B., et al. (2018) · Clinical Diabetes · doi:10.2337/cd17-0094 · Cited by 87 · see citing works
Closed-Loop Insulin Therapy Improves Glycemic Control in Children Aged <7 Years
Dauber, A. N., Corcia, L., Safer, J., Agus, M. S. D., Einis, S., & Steil, G. M. (2012) · Diabetes Care · doi:10.2337/dc12-1079 · Cited by 74 · see citing works
Randomized Controlled Trial of Mobile Closed-Loop Control
Kovatchev, B., Anderson, S. M., Raghinaru, D., Kudva, Y. C., Laffel, L. M., Levy, C., Pinsker, J. E., Wadwa, R. P., Buckingham, B., Doyle, F. J., et al. (2020) · Diabetes Care · doi:10.2337/dc19-1310 · Cited by 60 · see citing works
Glycemic Outcomes of Use of CLC Versus PLGS in Type 1 Diabetes: A Randomized Controlled Trial
Brown, S. A., Beck, R. W., Raghinaru, D., Buckingham, B. A., Laffel, L. M., Wadwa, R. P., Kudva, Y. C., Levy, C. J., Pinsker, J. E., Dassau, E., et al. (2020) · Diabetes Care · doi:10.2337/dc20-0124 · Cited by 55 · see citing works
Performance of an Artificial Pancreas System for Young Children with Type 1 Diabetes
DeBoer, M. D., Breton, M. D., WAKEMAN, C. A., Schertz, E. M., Emory, E. G., Robic, J. L., Kollar, L. L., Kovatchev, B. P., & Cherñavvsky, D. R. (2017) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2016.0424 · Cited by 49 · see citing works
Lu, J., Ma, X., Zhang, L., Mo, Y., Lu, W., Zhu, W., Bao, Y., Jia, W., & Zhou, J. (2020) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2020.108032 · Cited by 49 · see citing works
Kovatchev, B. P., Kollar, L. L., Anderson, S. M., Barnett, C. L., Breton, M. D., Carr, K., Gildersleeve, R., Oliveri, M. C., WAKEMAN, C. A., & Brown, S. A. (2020) · The Lancet Digital Health · doi:10.1016/s2589-7500(19)30218-3 · Cited by 47 · see citing works
Dai, X., Luo, Z.-C., Zhai, L., Zhao, W., & Huang, F. (2018) · Diabetes Therapy · doi:10.1007/s13300-018-0436-y · Cited by 37 · see citing works
Brown, S. A., Breton, M. D., Anderson, S. M., Kollar, L. L., Keith-Hynes, P., Levy, C. J., Lam, D. W.-H., Levister, C. M., Baysal, N., Kudva, Y. C., et al. (2017) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2017-00556 · Cited by 30 · see citing works
Thrower, S., & Bingley, P. J. (2011) · British Medical Bulletin · doi:10.1093/bmb/ldr020 · Cited by 26 · see citing works
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Boughton, C. K., & Hovorka, R. (2024) · Diabetologia · doi:10.1007/s00125-024-06165-w · Cited by 57 · see citing works
Significance of the CGM metric of time in range in children and adolescents with type 1 diabetes
Urakami, T. (2022) · Endocrine Journal · doi:10.1507/endocrj.ej22-0257 · Cited by 11 · see citing works
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- Authors
- Jiao, X., Shen, Y., & Chen, Y.
- Affiliations
- Nanchang University (CN)
- Corresponding author
- Shen, Yunfeng
- Venue
- BMJ Open Diabetes Research & Care
- Publisher
- BMJ
- Published
- 2022-04
- Volume
- 10
- Issue
- 2
- Pages
- e002633
- ISSN
- 2052-4897 (ISSN-L)
- PMC
- PMC9024214
- OpenAlex
- W4224226454
- Cited by
- 76
- References
- 40
- Citations by year
- 2026: 14 · 2025: 22 · 2024: 26 · 2023: 12 · 2022: 1
- FWCI
- 2.17
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open Diabetes Research & Care (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Program of Jiangxi Province (20192BBG70027)
- National Natural Science Foundation of China (81860151)
- 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, continuous glucose monitoring, insulin pump therapy, glycemic control, time in range, HbA1c, hypoglycemia, glycemic variability, insulin dose, quality of life, children and adults
- MeSH terms
- Adult, Child, Diabetes Mellitus, Type 1, Glucose, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Insulin, Regular, Human
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