Research Summary

Analyzed using Evidence Intelligence™

Insulin needs double in T1D with hybrid closed-loop therapy

Last updated July 12, 2026

Key finding

TDD increased from 27.2 ± 16.1 units/day at 0-3 months to 65.7 ± 24.9 units/day at 42-48 months.

This study analyzed insulin requirements in children and adolescents with Type 1 Diabetes using a closed-loop insulin delivery system. It found significant increases in total daily insulin doses and the proportion of basal insulin over 48 months.

Quick read

Study at a glance

The essential study design details in one scan.

EvidenceScore™

Moderate

Study type

RCTs

Follow-up

Medium-Term (3–12 mo)

Risk of bias

Some Concerns

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Plain-language summary

What this paper says

A plain-language read of the study’s main message and where it applies.

Study focus

Clinical relevance

Understanding insulin requirements is crucial for managing Type 1 Diabetes effectively. This study's findings suggest that closed-loop systems can significantly alter insulin delivery patterns, potentially improving glycemic control and reducing the burden of daily management for young patients and their families.

Keep in mind

The study did not provide clear effectiveness data. Sample size and demographic details were not specified. The long-term effects beyond 48 months were not assessed.

Published in

Journal Reference

Publication details and source links for this paper.

Chloë R, Julia W, Janet MA, et al. Insulin Requirements in Children and Adolescents with Type 1 Diabetes: A Secondary Analysis of a Hybrid Closed-Loop Trial. Diabetes technology & therapeutics. 2025;27(12):1008-1013. doi:10.1177/15209156251369882

View DOI View on PubMed View on PMC

Main Effects

Total daily dose (TDD) increased from 27.2 ± 16.1 units/day at 0-3 months to 65.7 ± 24.9 units/day at 42-48 months.

The proportion of total daily insulin delivered as basal insulin rose from 41% to 61% over 48 months.

Day-to-day variability of insulin requirements remained stable with a coefficient of variation at 0-3 months of 23.3 ± 0.9%.

Evidence network

How this study fits

Understand where this research contributes within the broader evidence network.

Evidence Context

This study contributes evidence to Hybrid closed-loop system and Day-to-day variability of insulin requirements measured as coefficient of variation, Proportion of total daily insulin delivered as basal insulin, Total daily insulin dose.

This study contributes evidence to

Intervention

Hybrid closed-loop system

Outcome

Day-to-day variability of insulin requirements measured as coefficient of variation

Primary intervention

Hybrid closed-loop system

Primary outcomes

Day-to-day variability of insulin requirements measured as coefficient of variation
Proportion of total daily insulin delivered as basal insulin
Total daily insulin dose

Primary intervention

Hybrid closed-loop system

Primary outcomes

Day-to-day variability of insulin requirements measured as coefficient of variation Proportion of total daily insulin delivered as basal insulin Total daily insulin dose

Evidence relationships

Intervention and outcome relationships this study adds to the evidence network.

Evidence pairs

Relationships

Evidence topics

contributes_evidence

Editorial context

Why this study matters

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Evidence network role

This section describes how the study fits into the current evidence network. It does not determine whether an intervention works on its own.

Moderate contributionModerate confidenceNetwork score: 54

Why it is useful

Contributes to 3 evidence relationships
Includes primary outcome data
Linked to 0 direct semantic evidence topics

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Primary evidence

Evidence relationship

Insulin Delivery Systems and Insulin Resistance

Related evidence

Intervention

Insulin Delivery Systems

Save evidence

Outcome

Insulin Resistance

Save evidence

Core evidence

Study findings

The primary outcomes reported in this study.

Day-to-day variability of insulin requirements measured as coefficient of variation

Hybrid closed-loop system → Day-to-day variability of insulin requirements measured as coefficient of variation

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 50; Neutral
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

Add to Evidence Tracker

Proportion of total daily insulin delivered as basal insulin

Hybrid closed-loop system → Proportion of total daily insulin delivered as basal insulin

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 100; Very Positive
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

Add to Evidence Tracker

Total daily insulin dose

Hybrid closed-loop system → Total daily insulin dose

Evidence Intelligence™

EvidenceScore™: Moderate; Score 69 · Based on 2 studies
ImpactScore™: 38; Slightly Negative
ConsistencyScore™: 100; consistent

Based on 2 studies

Add to Evidence Tracker

Evidence Library

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Evidence Suggest

Total daily insulin dose increased by 38.5 units/day.
Proportion of basal insulin increased by 20%.
Day-to-day variability in insulin needs showed no significant change.

Who this applies to

Children and adolescents diagnosed with Type 1 Diabetes.
Patients utilizing closed-loop insulin delivery systems.

Keep in Mind

The effectiveness of the closed-loop system remains unclear.
Results may not be generalizable to all populations.
Further research is needed to assess long-term outcomes.

Between the Lines

The study did not provide clear effectiveness data.
Sample size and demographic details were not specified.
The long-term effects beyond 48 months were not assessed.

Evidence Library

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Connected Evidence

Explore related studies, evidence collections, and research questions.

Relationships organized using the Dediabetes Evidence Intelligence™ framework.

This study contributes to evidence on Insulin Delivery Systems and Insulin Resistance, Insulin Delivery Systems and Day-to-day variability of insulin requirements measured as coefficient of variation.

Related evidence relationships

Explore in Evidence Explorer

This study contributes to the evidence on the following intervention-outcome relationships.

Devices & Technology

Detailed evidence

Insulin Delivery Systems → Insulin Resistance

Devices & Technology

Evidence Intelligence™

EvidenceScore™: Moderate; Score 69 · Based on 2 studies
ImpactScore™: 38; Slightly Negative
ConsistencyScore™: 100; consistent

Based on 2 studies

View evidence

Devices & Technology

Detailed evidence

Insulin Delivery Systems → Day-to-day variability of insulin requirements measured as coefficient of variation

Devices & Technology

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 50; Neutral
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

View evidence

Included in these evidence collections

Curated evidence collections and hubs this study is part of.

Insulin Delivery Systems Evidence Hub

All studies on Insulin Delivery Systems

2 studies

intervention_hub

Contributes to Insulin Delivery Systems evidence base.

Insulin Resistance Evidence Hub

All studies measuring Insulin Resistance

2 studies

outcome_hub

Measures Insulin Resistance as a key outcome.

Day-to-day variability of insulin requirements measured as coefficient of variation Evidence Hub

All studies measuring Day-to-day variability of insulin requirements measured as coefficient of variation

1 studies

outcome_hub

Measures Day-to-day variability of insulin requirements measured as coefficient of variation as a key outcome.

Recent Diabetes Research

Latest published studies

recency_collection

Published within the last 2 years.

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All studies on Hybrid closed-loop system and Total daily insulin dose

Intervention: Hybrid closed-loop systemOutcome: Total daily insulin dose

2 results

All studies on Hybrid closed-loop system and Day-to-day variability of insulin requirements measured as coefficient of variation

Intervention: Hybrid closed-loop systemOutcome: Day-to-day variability of insulin requirements measured as coefficient of variation

1 results

All studies on Hybrid closed-loop system

Intervention: Hybrid closed-loop system

2 results

All studies measuring Total daily insulin dose

Outcome: Total daily insulin dose

2 results

All studies measuring Day-to-day variability of insulin requirements measured as coefficient of variation

Outcome: Day-to-day variability of insulin requirements measured as coefficient of variation

1 results

Questions answered by this study

Generated from the study's connected evidence using Evidence Intelligence™.

Does Insulin Delivery Systems improve insulin resistance?

Moderate Evidence

Insulin Delivery Systems may worsen Insulin Resistance or be associated with harm.

ConsistencyScore™: Results are consistent across studies.

Ranked evidence signals

1
Total daily insulin dose
EvidenceScore™ Moderate | EvidenceScore™ 69.0 | weak negative | ConsistencyScore™ Consistent | 1 study

Why this answer: This answer is based on a small number of supporting studies and should be interpreted cautiously.

Limitations

Only a small number of supporting studies are available.
Population details are unavailable.

View Full Evidence

Does Hybrid closed-loop system improve proportion of total daily insulin delivered as basal insulin?

Emerging Evidence

Hybrid closed-loop system appears to improve Proportion of total daily insulin delivered as basal insulin.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

1
Proportion of total daily insulin delivered as basal insulin
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

Only one supporting study is available.
Consistency cannot yet be determined.
Population details are unavailable.

View Full Evidence

Does Hybrid closed-loop system improve day-to-day variability of insulin requirements measured as coefficient of variation?

Emerging Evidence

Current evidence does not show a clear benefit of Hybrid closed-loop system for Day-to-day variability of insulin requirements measured as coefficient of variation.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

1
Day-to-day variability of insulin requirements measured as coefficient of variation
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | neutral | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

Only one supporting study is available.
Consistency cannot yet be determined.
Population details are unavailable.

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All studies on Hybrid closed-loop system and Total daily insulin dose All studies on Hybrid closed-loop system and Proportion of total daily insulin delivered as basal insulin All studies on Hybrid closed-loop system and Day-to-day variability of insulin requirements measured as coefficient of variation

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