Hybrid closed-loop artificial pancreas system improves blood sugar control better than insulin injections in hospitalized type 1 diabetes

Low confidence

very high bias

Last updated May 15, 2026

Key takeaway:

A 28-year-old woman with long-standing type 1 diabetes had better blood sugar control and fewer low blood sugar episodes when using a hybrid closed-loop artificial pancreas system compared to multiple insulin injections during a hospital stay.

Study at a glance

What was studied

Hybrid closed-loop artificial pancreas versus multiple insulin injections in hospitalized type 1 diabetes

Study type

non-randomized clinical trial (non-RCT or NRCT)

duration

Short-Term (≤3 mo)

Intervention

Hybrid closed-loop system

Outcomes

Time in range, Time below range, Blood glucose, Time above range, Hypoglycemia events, Glucose variability

Funding

Non-industry sponsored

Main effects

↑ Time in target range (3.9-10 mmol/L): increased from 65% to 87%

↓ Severe hypoglycemia: reduced from 1.8% to 0.4% of time

↓ Mean blood glucose: decreased from 8.03 to 6.93 mmol/L

Evidence Summary

Intervention	Outcome	Measured Change	Study Effect
Hybrid closed-loop system (Devices & Technology)	Blood glucose (Glycemic Control)	Decrease	Strong
Hybrid closed-loop system (Devices & Technology)	Glucose variability (Glycemic Control)	Decrease	Strong
Hybrid closed-loop system (Devices & Technology)	Hypoglycemia events (Safety)	Decrease	Strong
Hybrid closed-loop system (Devices & Technology)	Time above range (Glycemic Control)	Decrease	Strong
Hybrid closed-loop system (Devices & Technology)	Time below range (Glycemic Control)	Decrease	Strong
Hybrid closed-loop system (Devices & Technology)	Time in range (Glycemic Control)	Increase	Strong

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Evidence Suggest

HCL system significantly increased time in range compared to multiple daily injections (87% vs 65%, p<0.05)
Automated insulin delivery reduced severe low blood sugar events (glucose <3.0 mmol/L) by 78%
Blood sugar fluctuations were smoother throughout the day and night, especially after meals and during sleep

Who this applies to

This case involved a 28-year-old woman with long-standing type 1 diabetes (17 years), elevated HbA1c (11.9%), history of poor glucose control, and frequent hypoglycemia. The findings may be most relevant for adults with type 1 diabetes who have difficulty achieving stable glucose control with insulin injections, particularly those experiencing frequent low blood sugar episodes.

Keep in Mind

This is a single case report, not a controlled study with multiple participants, so the results should be interpreted cautiously. The patient was hospitalized and closely monitored, which may not reflect typical outpatient care. The Android-based hybrid closed-loop system used is a do-it-yourself (DIY) system that is not commercially approved or regulated in China, and requires significant technical knowledge to set up and maintain. The cost of insulin pumps and CGM devices is not covered by medical insurance in China, limiting accessibility for most patients.

Between the Lines

Case report of only one patient - results may not apply to all people with type 1 diabetes
Short observation period of just 7 days for each treatment method
Patient was hospitalized, so results may differ in outpatient or real-world settings
AndroidAPS system is not commercially approved in China and requires technical expertise to set up

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Journal Reference

Li S, Lv P, Lu H, et al. Initiation of Hybrid Closed-Loop Artificial Pancreas System Improves Glycemic Control in a Hospitalized Type 1 Diabetes: A Case Report and Review. Case Rep Endocrinol. 2026;2026:8925266. doi:10.1155/crie/8925266