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.

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.