Cited by 23Diabetes Management and ResearchGastrointestinal motility and disordersDiabetes Treatment and Management

Hybrid Closed-loop to Manage Gastroparesis in People With Type 1 Diabetes: a Case Series

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Daly, Aideen, Hartnell, Sara, Boughton, Charlotte K., Evans, Mark·2021·Journal of Diabetes Science and Technology

Abstract

Background: Gastroparesis is associated with unpredictable gastric emptying and can lead to erratic glucose profiles and negative impacts on quality-of-life. Many people with gastroparesis are unable to meet glycemic targets and there is a need for new approaches for this population. Hybrid closed-loop systems improve glucose control and quality-of-life but evidence for their use in people with diabetic gastroparesis is limited. Methods: We present a narrative review of the challenges associated with type 1 diabetes management for people with gastroparesis and present a case series of 7 people with type 1 diabetes and gastroparesis. We compare glycemic control before and during the first 12 months of hybrid closed-loop therapy. Data were analyzed using electronic patient records and glucose management platforms. We also discuss future advancements for closed-loop systems that may benefit this population. Results: Five of 7 patients had data available for time in range before and during hybrid closed-loop therapy, and all had an improvement in percentage time in target glucose range, with the overall mean time in range increasing from 26.0% ± 15.7% to 58.4% ± 8.6% during HCL use, ( P = .004). There were significant reductions in HbA1c (83 ± 9 mmol/mol to 71 ± 14 mmol/mol) and mean glucose from 13.0 ± 1.7 mmol/L (234 ± 31 mg/dL) to 10.0 ± 0.7 mmol/L (180 ± 13 mg/dL) with use of a hybrid closed-loop system. Importantly, this was achieved without an increase in time in hypoglycemia ( P = .50). Conclusion: Hybrid closed-loop systems may represent a valuable approach to improve glycemic control for people with type 1 diabetes and gastroparesis. Prospective studies are required to confirm these findings.

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  • Available data suggest that hybrid closed‐loop systems (Automated Insulin Delivery, AID) can increase TIR and reduce hypoglycemia in patients with DGP, with improvements comparable to those observed in individuals without gastrointestinal complications, although data remain limited and largely observational.

    “Avaiable data suggest that such systems can increase TIR and reduce hypoglycemia in patients with DGP, with improvements comparable to those observed in individuals without gastrointestinal complications, although data remain limited and largely observational [153–157].”

    From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [153]

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Authors
Daly, A., Hartnell, S., Boughton, C. K., & Evans, M.
Affiliations
  • University of Cambridge (GB)
  • Cambridge University Hospitals NHS Foundation Trust (GB)
Corresponding author
Daly, Aideen
Venue
Journal of Diabetes Science and Technology
Published
2021-08-11
Volume
15
Issue
6
Pages
1216-1223
ISSN
1932-2968 (ISSN-L)
OpenAlex
W3188994002
Cited by
23
References
46
Citations by year
2026: 6 · 2025: 6 · 2024: 3 · 2023: 5 · 2022: 3
FWCI
2.05
Type
journal article
Language
en
Open access
Locations
  • Journal of Diabetes Science and Technology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • Apollo
Funders
National Institute for Health and Care Research (CL-2020-14-801)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
hybrid closed-loop insulin delivery, type 1 diabetes, diabetic gastroparesis, glycemic control, time in range, HbA1c, hypoglycemia, gastric emptying
MeSH terms
Blood Glucose, Diabetes Mellitus, Type 1, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Blood Glucose Self-Monitoring, Gastroparesis

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