Diabetes, obesity & metabolism · 2026
Clinical outcomes of adults with type 1 diabetes and comorbid depression and/or anxiety disorders using hybrid closed-loop: A retrospective study from a multidisciplinary tertiary centre.
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Croos Jonathan, Shooshtarian Adam Kia, Stotesbury Ben, Gallen Geraldine, Ismail Khalida, Rosenthal Miranda, Cheah Yee, Calcia Marilia, Lovie Kaylee, Ahuja Anusha, Shrestha Aakanksha, Tan Rachael J L, Stadler Marietta
Аннотация
AIMS: Retrospective study evaluating real-world outcomes of hybrid closed-loop (HCL) in adults with type 1 diabetes and comorbid depression and/or anxiety disorders.
MATERIALS AND METHODS: Adults with type 1 diabetes and comorbid depression/anxiety disorders attending King's College Hospital diabetes centre between October 2023 and January 2025 were included. Demographic, medical and psychiatric information, acute diabetes complication rates, two-item diabetes distress scale (DDS2) scores and sensor glucometrics (time in range; TIR) were extracted from electronic health records and diabetes technology platforms.
RESULTS: Of 1827 adults with type 1 diabetes, 226 had comorbid depressive and/or anxiety disorders [163 female/63 male; age 38 (IQR: 29.0-51.3) years, 23 (15-33.3) years diabetes duration]; 196 had depression and 119 had anxiety disorders. HCL-users (n = 108; 89 female/19 male) had lower glycated haemoglobin A1c (HbA1c) and higher TIR [HbA1c 60.0 mmol/mol (7.6%) (53.0-66.0/7.0-8.2) vs. 73.0 mmol/mol (8.8%) (58.5-85.5/7.5-10.0), p < 0.001; TIR 63.5 (55.8-75.0) vs. 42.0 (23.0-55.3), p < 0.001] than non-HCL users (n = 118, 44 female/74 male) at last follow-up compared to baseline. Glycaemia improved post HCL-initiation compared to pre-HCL [HbA1c 60.0 mmol/mol (7.6%) (53.0-66.0/7.0-8.2) vs. 67.5 mmol/mol (8.3%) (58.8-77.8/7.5-9.3), p < 0.001; TIR 63.5 (55.8-75.0) vs. 39.0 (28.0-55.8), p < 0.001]. Severe hypoglycaemia rates did not vary (p = 0.380), but fewer HCL users experienced ketoacidosis (p < 0.001). DDS2 scores were lower post-HCL (p = 0.004) but not when comparing HCL and non-HCL users (p = 0.230).
CONCLUSIONS: HCL users demonstrated improved HbA1c and TIR, compared with non-HCL users. These real-world data support safe use of HCL in people with type 1 diabetes and depression/anxiety in a multidisciplinary setting. Qualitative studies and prospective trials are required to further evaluate the impact of HCL on biomedical and mental health outcomes.
MATERIALS AND METHODS: Adults with type 1 diabetes and comorbid depression/anxiety disorders attending King's College Hospital diabetes centre between October 2023 and January 2025 were included. Demographic, medical and psychiatric information, acute diabetes complication rates, two-item diabetes distress scale (DDS2) scores and sensor glucometrics (time in range; TIR) were extracted from electronic health records and diabetes technology platforms.
RESULTS: Of 1827 adults with type 1 diabetes, 226 had comorbid depressive and/or anxiety disorders [163 female/63 male; age 38 (IQR: 29.0-51.3) years, 23 (15-33.3) years diabetes duration]; 196 had depression and 119 had anxiety disorders. HCL-users (n = 108; 89 female/19 male) had lower glycated haemoglobin A1c (HbA1c) and higher TIR [HbA1c 60.0 mmol/mol (7.6%) (53.0-66.0/7.0-8.2) vs. 73.0 mmol/mol (8.8%) (58.5-85.5/7.5-10.0), p < 0.001; TIR 63.5 (55.8-75.0) vs. 42.0 (23.0-55.3), p < 0.001] than non-HCL users (n = 118, 44 female/74 male) at last follow-up compared to baseline. Glycaemia improved post HCL-initiation compared to pre-HCL [HbA1c 60.0 mmol/mol (7.6%) (53.0-66.0/7.0-8.2) vs. 67.5 mmol/mol (8.3%) (58.8-77.8/7.5-9.3), p < 0.001; TIR 63.5 (55.8-75.0) vs. 39.0 (28.0-55.8), p < 0.001]. Severe hypoglycaemia rates did not vary (p = 0.380), but fewer HCL users experienced ketoacidosis (p < 0.001). DDS2 scores were lower post-HCL (p = 0.004) but not when comparing HCL and non-HCL users (p = 0.230).
CONCLUSIONS: HCL users demonstrated improved HbA1c and TIR, compared with non-HCL users. These real-world data support safe use of HCL in people with type 1 diabetes and depression/anxiety in a multidisciplinary setting. Qualitative studies and prospective trials are required to further evaluate the impact of HCL on biomedical and mental health outcomes.
Предметные рубрики MeSH
HumansDiabetes Mellitus, Type 1MaleFemaleRetrospective StudiesAdultAnxiety DisordersInsulin Infusion SystemsMiddle AgedComorbidityInsulinBlood GlucoseTertiary Care CentersGlycated HemoglobinYoung AdultTreatment OutcomeHypoglycemic AgentsDepressionAdolescentHypoglycemiaBlood Glucose Self-MonitoringContinuous Glucose MonitoringGlycemic Control