TOPLINE:

In a multidisciplinary clinical setting, the use of hybrid closed-loop (HCL) systems was linked to lower A1c levels and higher time in range in adults with type 1 diabetes (T1D) and comorbid depression and/or anxiety disorders, without an increase in hypoglycaemic events.

METHODOLOGY:

• This retrospective study at a multidisciplinary clinical setting in England evaluated real‑world outcomes of HCL systems in 226 adults with T1D and comorbid depression and/or anxiety disorders (median age, 38 years; 72% women); 47.8% of them used HCL systems and the rest used alternative modes of insulin therapy.
• Data, including demographic information, medical and psychiatric records, rates of acute diabetes complications, two‑item Diabetes Distress Scale scores, and sensor glucometrics, were extracted from electronic health records and diabetes‑technology platforms.
• Analysed glycaemic parameters included A1c levels and 14-day continuous glucose monitoring (CGM) metrics: time above range (> 13.9 mmol/L), time in range (3.9-10.0 mmol/L), and time below range (< 3.0 mmol/L); CGM data were analysed when sensor usage was more than 70%.
• Patient-reported episodes of diabetic ketoacidosis and severe hypoglycaemia were captured for 12 months before and after the initiation of HCL therapy; for non-HCL users, events from the prior 12 months were recorded.

TAKEAWAY:

• HCL users showed better glycaemic control than non-HCL users, with lower median A1c levels (60.0 vs 73.0 mmol/mol) and higher median time in range (64.0% vs 43.0%; P < .001 for both).
• After the initiation of HCL therapy, A1c levels decreased by 7.2 mmol/mol and the time in range increased by a mean of 21.4% (P < .001 for both), without increasing the time below range.
• Two-item Diabetes Distress Scale scores also reduced after the initiation of HCL therapy (P = .004); however, these scores did not differ between HCL and non‑HCL users at the last follow‑up (P = .230).
• Rates of diabetic ketoacidosis and severe hypoglycaemia did not change from pre‑ to post‑HCL therapy; however, diabetic ketoacidosis was less common among HCL users than among non‑HCL users.

IN PRACTICE:

"This real-world retrospective analysis clearly demonstrates that HCL provides significant improvements in glycaemic control, specifically HbA1c [A1c] and TIR [time in range], without increasing time spent in hypoglycaemia in people with type 1 diabetes and comorbid depression/anxiety," the authors wrote.

SOURCE:

This study was led by Jonathan Croos and Adam Kia Shooshtarian, King's College London, London, England. It was published online on January 20, 2026, in Diabetes, Obesity and Metabolism.

LIMITATIONS:

The single-centre retrospective design may have limited the generalisability of the findings to other settings. The cohort was preselected by the multidisciplinary team as suitable for HCL therapy, potentially introducing selection bias. The analysis was constrained by the reliance on reports closest to the initiation of HCL therapy and on the most recent post-HCL assessments.

DISCLOSURES:

This study was supported by the National Institute for Health and Care Research (NIHR) and the NIHR Mental Health Biomedical Research Centre at South London. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.