Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jun;22(6):875-892.
doi: 10.1080/17425247.2025.2492363. Epub 2025 Apr 18.

Closed-loop therapy: recent advancements and potential predictors of glycemic outcomes

Chloë Royston  1 , Roman Hovorka  1 , Charlotte K Boughton  1
Affiliations
Review

Closed-loop therapy: recent advancements and potential predictors of glycemic outcomes

Chloë Royston et al. Expert Opin Drug Deliv. 2025 Jun.

Abstract

Introduction: Hybrid closed-loop systems have become the standard of care for managing type 1 diabetes (T1D). Both clinical trials and real-world data have demonstrated that these systems improve glycemic control without increasing the risk of hypoglycemia, while also reducing the overall burden of T1D management. A systematic literature search was conducted using PubMed for studies including individuals with T1D that were published until the end of 2024.

Areas covered: In this review, we summarize the safety and efficacy of currently available hybrid closed-loop systems, drawing from key clinical trials and real-world data analyses. We also highlight recent advancements in closed-loop systems, discuss their limitations and barriers to access, and explore future directions for automated insulin delivery. Finally, we explore potential predictors of outcomes for people with T1D to better understand why some individuals respond better to closed-loop systems than others.

Expert opinion: Closed-loop systems are advancing rapidly, with a growing focus on enhancing automation through fully closed-loop systems to improve glycemic control and further reduce the burden of management. Identifying the predictors that influence how individuals respond to closed-loop therapy will enable these systems to be optimized. It is crucial to ensure widespread and equitable access to this advanced technology.

Keywords: Automated insulin delivery; fully closed-loop; hybrid closed-loop; time in range; type 1 diabetes.

PubMed Disclaimer

Conflict of interest statement

Declarations of Interest

R Hovorka received speaker honoraria from Sandoz, Abbott Diabetes Care, and NovoNordisk, receiving consultancy fees from Abbott Diabetes Care, patents related to closed-loop, and is director at CamDiab. CK Boughton has received consultancy fees from CamDiab and speaker honoraria from Ypsomed and the Association of British Clinical Diabetologist’s Diabetes Technology Network. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1
Figure 1
Generic closed loop figure in systems where the algorithm is housed on (a) the insulin pump (b) a compatible mobile device (created in BioRender.com. Boughton, C. (2025) https://BioRender.com/h83p169)
Figure 2
Figure 2
Commercially available automated insulin delivery systems (a) CamAPS FX (b) Diabeloop (c) iLet (d) Medtronic 780G (e) Insulet Omnipod 5 (f) Tandem t:slim and Mobi Control-IQ
Figure 3
Figure 3
Potential predictors of glycemic outcomes with closed-loop therapy (created in BioRender.com. Boughton, C. (2025) https://BioRender.com/y71f165)
See this image and copyright information in PMC

References

    1. D’Souza D, Empringham J, Pechlivanoglou P, Uleryk EM, Cohen E, Shulman R. Incidence of diabetes in children and adolescents during the COVID-19 pandemic: a systematic review and meta-analysis. JAMA Netw Open. 2023;6(6):e2321281. doi: 10.1001/jamanetworkopen.2023.21281. - DOI - PMC - PubMed
    1. Mahase E. Type 1 diabetes: global prevalence is set to double by 2040, study estimates. BMJ. 2022;378:o2289. - PubMed
    1. Boughton CK, Hovorka R. The role of automated insulin delivery technology in diabetes. Diabetologia. 2024;67(10):2034–44. doi: 10.1007/s00125-024-06165-w. - DOI - PMC - PubMed
    1. Jiao X, Shen Y, Chen Y. Better TIR, HbA1c, and less hypoglycemia in closed-loop insulin system in patients with type 1 diabetes: a meta-analysis. BMJ Open Diabetes Res Care. 2022;10(2):e002633. doi: 10.1136/bmjdrc-2021-002633. - DOI - PMC - PubMed
    1. Phillip M, Nimri R, Bergenstal RM, Barnard-Kelly K, Danne T, Hovorka R, et al. Consensus recommendations for the use of automated insulin delivery technologies in clinical practice. Endocr Rev. 2023;44(2):254–80. doi: 10.1210/endrev/bnac022. - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources