From the Guidelines
Closed-loop (automated) insulin pump systems are recommended for type 1 diabetes patients due to their ability to improve glycemic control, reduce hypoglycemia risk, and enhance quality of life, as evidenced by the most recent study in 2025 1. The primary benefits of closed-loop systems include more time in the target glucose range, fewer severe hypoglycemic episodes, improved overnight glucose control, reduced diabetes management burden, and potential long-term reduction in complications.
- Improved glycemic control: Closed-loop systems have been shown to reduce HbA1c levels by 0.2-0.5% compared to basal-bolus insulin therapy 1.
- Reduced hypoglycemia risk: Automated insulin delivery systems can suspend insulin delivery at a preset glucose level, reducing the risk of nocturnal hypoglycemia 1.
- Enhanced quality of life: Closed-loop systems can reduce the burden of diabetes management, allowing patients to spend less time monitoring their glucose levels and adjusting their insulin doses 1. However, risks and considerations include:
- Technical failures: Sensor inaccuracies, connectivity issues, or algorithm limitations can occur 1.
- Over-reliance on automation: Patients may need to manually adjust their insulin doses or respond to system alerts 1.
- Infection risk: Insertion sites can become infected, and patients must follow proper hygiene and maintenance procedures 1.
- Cost barriers: Closed-loop systems can be expensive, and access may be limited for some patients 1. Despite these considerations, most patients experience significant improvements in diabetes management with closed-loop systems, with studies showing users typically achieve 70-80% time in range compared to 50-60% with traditional methods 1. Patient education, regular follow-up with healthcare providers, and maintaining basic diabetes management skills remain essential for optimal outcomes with this technology 1.
From the Research
Risks and Benefits of Closed-Loop Diabetic Pumps
- The use of closed-loop diabetic pumps, also known as artificial pancreas, has been shown to improve glycemic control and reduce the risk of hypoglycemia in patients with type 1 diabetes 2, 3, 4.
- A study published in 2019 found that hybrid closed-loop control reduced the risk and frequency of hypoglycemia, while improving time in target range and reducing hyperglycemia in people at moderate to high risk of hypoglycemia 3.
- Another study published in 2017 found that day-and-night hybrid closed-loop insulin delivery improved glucose control and reduced hypoglycemia burden in adults with type 1 diabetes and HbA1c below 7·5% 4.
- The use of glucagon in closed-loop systems has been shown to minimize hypoglycemia and improve safety 5.
- The use of multiple sensors and predictive algorithms can also improve the accuracy and safety of closed-loop systems 5.
Indications and Contraindications
- Closed-loop diabetic pumps are indicated for patients with type 1 diabetes who are at moderate to high risk for hypoglycemia 3.
- The use of closed-loop systems may be contraindicated in patients with certain medical conditions, such as pregnancy or history of severe hypoglycemia, although some studies have shown that closed-loop systems can be safe and effective in these populations 2, 4.
- Further research is needed to fully understand the indications and contraindications for closed-loop diabetic pumps.
Contract Indications
- The contract indications for closed-loop diabetic pumps are not well established, but may include patients with type 1 diabetes who are unable to achieve adequate glycemic control with traditional insulin therapy 6.
- The use of closed-loop systems may require significant resources and patient education, and may not be suitable for all patients with type 1 diabetes 6.