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Hybrid closed loop technology

Hybrid closed loop technology – also known as the artificial pancreas or automated insulin delivery – automates many of the decisions that you have to make on a daily basis when you have type 1 diabetes.
Content last reviewed and updated: 13.03.2024

What is hybrid closed loop technology?

A hybrid closed loop system takes readings from a continuous glucose monitor and uses an algorithm to tell an insulin pump how much insulin to deliver. It does this 24 hours a day.

How does hybrid closed loop technology work?

If you have type 1 diabetes, you already use a treatment loop – you measure your blood glucose levels, work out how much insulin you need, then take a dose of insulin. For this, you need a blood glucose meter, your brain, and an insulin pen.

If you’re using a hybrid closed loop system, you use a CGM instead of a blood glucose meter, an insulin pump instead of a pen, and an algorithm instead of your brain.

The CGM tells the algorithm what your glucose levels are and the algorithm tells the pump how much insulin to deliver. It will pause the flow of insulin if your levels are low or increase the flow if your levels are high.

However, you will still need to check the system is working. You’ll also need to count carbs and be aware of how quickly carbohydrate will reach your bloodstream, so that you can give the system correct bolusing data before you eat.

The pros and cons of hybrid closed loop technology

The pros

Reducing the burden of type 1 diabetes decisions

By automating the treatment loop, hybrid closed loop systems can dramatically reduce the number of decisions you have to make every day.

With hybrid closed loop systems, you can spend more time with your glucose levels in range, with less effort. For example, if you have a hypo whilst sleeping, hybrid closed loop technology will temporarily turn off the delivery of insulin to minimise the time you spend below target range. Your insulin will also be slowed or turned off if the sensor detects that glucose levels are likely to dip into a hypo.

Similarly, if the sensor detects that your glucose level is likely to rise above target, it will temporarily increase the basal rate or deliver small corrective boluses – or a combination of both.

The cons

Using a hybrid closed loop system eases the burden of type 1 but doesn’t mean that type 1 treatment is completely automated. For example, you still need to count carbs and give the system bolusing information when you eat.

You will still need to keep an eye on your glucose levels and take action if the system isn’t keeping your glucose in target range, which might suggest that your insulin infusion site isn’t working well. As you only use rapid acting insulin with a hybrid closed loop system, you can quickly develop ketones if your glucose rises and stays high due to technical issues. Part of the training you will receive when you start on HCL includes how to recognise when high glucose needs more than a correction bolus.

What hybrid closed loop systems are available?

There are several hybrid closed loop systems available that work with a variety of pumps and CGMs. Talk to your Diabetes Healthcare Team about what might be available to you.

  • CamAPS FX hybrid closed loop uses a DANA  insulin pump and Dexcom CGM, or a Ypsomed insulin pump with a Dexcom CGM or Libre 3. Licenced for aged 1+
  • Medtronic 670G + Guardian sensors hybrid closed loop uses Medtronic insulin pump and sensors. Licenced for aged 7+
  • Medtronic 780G + Guardian sensors hybrid closed loop uses Medtronic insulin pump and sensors. Licenced for aged 7+
  • Control IQ hybrid closed loop uses Tandem t:slim insulin pump and Dexcom G6 or G7 CGM. Licenced for those aged 4+
  • Omnipod 5 is a tubeless system using Omnipod insulin pumps and Dexcom G6 CGM. Licenced for aged 2+

Visit the Association of British Clinical Diabetologists for more expert opinions on hybrid closed loop systems.

Hybrid closed loop or artificial pancreas?

You may have heard this technology referred to as either artificial pancreas or hybrid closed loop, or both.

It’s called the artificial pancreas because the system tries to replicate what the insulin-producing beta cells in the pancreas do in someone without type 1. Some people aren’t happy with this, because it makes it sound like the person using an artificial pancreas has the equivalent of a fully functioning pancreas, which isn’t true because it still takes effort to make sure the system works properly.

Also, the pancreas does other things besides regulating glucose which aren’t affected by having type 1 diabetes – so the pancreas is still doing part of its job.

Some people prefer to say hybrid closed loop; ‘closed loop’ because it closes the treatment loop as explained above, and ‘hybrid’ because you still need to manage some aspects manually, alongside the automated parts.

Automated insulin delivery is another term for HCL which is being used more often.

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