Efficacy of the hybrid closed-loop insulin delivery system in children and adolescents with type 1 diabetes: a meta-analysis with trial sequential analysis

• Published in: Archives of Endocrinology and Metabolism 2024-04, Vol.68
• Main Authors: Ferreira, Rafael Oliva Morgado, Trevisan, Talita, Pasqualotto, Eric, Schmidt, Pedro, Chavez, Matheus Pedrotti, Watanabe, Janine Midori Figueiredo, Sande-Lee, Simone van de
• Format: Article
• Language: English
• Subjects: Closed-loop; diabetes technology; glucose control; Review; type 1 diabetes, meta-analysis
• ISSN: 2359-3997; 2359-4292
• DOI: 10.20945/2359-4292-2023-0280

The aim of this study was to assess the efficacy and safety of hybrid closed-loop (HCL) systems for insulin delivery in children and adolescents with type 1 diabetes (T1D). We searched Embase, PubMed, and Cochrane Library for randomized controlled trials (RCTs) published until March 2023 comparing the HCL therapy with control therapies for children and adolescents with T1D. We computed weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) with 95% confidence intervals (CIs) for binary endpoints. Four RCTs and 501 patients were included, of whom 323 were randomized to HCL therapy. Compared with control therapies, HCL significantly improved the period during which glucose level was 70-180 mg/dL (WMD 10.89%, 95% CI 8.22-13.56%) and the number of participants with glycated hemoglobin (HbA1c) level < 7% (RR 2.61, 95% CI 1.29-5.28). Also, HCL significantly reduced the time during which glucose level was > 180 mg/dL (WMD -10.46%, 95% CI -13.99 to -6.93%) and the mean levels of glucose (WMD -16.67 mg/dL, 95% CI -22.25 to -11.09 mg/dL) and HbA1c (WMD -0.50%, 95% CI -0.68 to -0.31). There were no significant differences between therapies regarding time during which glucose level was < 70 mg/dL or