Fast-tracking success: early hybrid closed loop initiation dramatically improves hba1c in the first year of care in CYP with type 1 diabetes

Tracey Stephenson; Juliet Stone; Jenny Evans

doi:10.1530/endoabs.111.OC7.4

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Endocrine Abstracts (2025) 111 OC7.4 | DOI: 10.1530/endoabs.111.OC7.4

BSPED2025 Oral Communications Diabetes Oral Communications 1 (5 abstracts)

Fast-tracking success: early hybrid closed loop initiation dramatically improves hba1c in the first year of care in CYP with type 1 diabetes

Tracey Stephenson , Juliet Stone & Jenny Evans

Author affiliations

Leeds Children’s Hospital, Leeds, United Kingdom

Introduction: Achieving HbA1c 48 mmol/mol or below is recommended within the first year of care (FYOC), to promote metabolic memory and reduce long-term complication risk. NICE now advocates managing type 1 diabetes (T1D) in children and young people (CYP) with hybrid closed loop (HCL) technology.

Methods: The Leeds CYP Diabetes team have embraced HCL technology with consideration moving earlier in their FYOC pathway since 2023. The current pathway aims for HCL initiation within 4 weeks of diagnosis. CYP diagnosed with T1D have been prospectively followed over the past 3 years with HbA1c collected at 3 monthly intervals within the FYOC and 6 monthly thereafter. Data is included for patients diagnosed longer than 3 months. Time to HCL initiation has also been monitored.

Results: 130 CYP have been diagnosed with T1D between June 2022-June 2025. 44 are currently in their FYOC. 87.7% are currently using HCL technology with 90.9% of those in their FYOC. Mean HbA1c for the current FYOC cohort has significantly reduced compared to the previous 2 years at each timepoint (table 1). This correlates with a reduction in mean time to HCL initiation (table 2). Mean time to HCL initiation has further reduced to 2.9 weeks over the past 6 months.

Table 1
Time Since Diagnosis	Mean HbA1c ( mmol/mol)
	Current	3m	6m	9m	12m	18m	24m	30m
3-12m (n = 37)	47.3 (n = 37)	47.3 (n = 35)	50.9 (n = 22)	50.2 (n = 13)	49.7 (n = 6)
12-24m (n = 47)	53.1 (n = 47)	53.2 (n = 46)	53.5 (n = 44)	55.8 (n = 46)	53.8 (n = 44)	53.9 (n = 25)
24-36m (n = 39)	55.2 (n = 38)	51.3 (n = 33)	52.6 (n = 34)	56.7 (n = 36)	58.6 (n = 37)	54.6 (n = 36)	56.7 (n = 34)	56.1 (n = 23)

Table 2
Time Since Diagnosis	Mean Time to Pump Start (weeks)
0-12m	7.8
12-24m	30.6
24-36m	64.3

Conclusion: Earlier HCL technology use has positively impacted mean HbA1c supporting the emerging evidence for HCL use within the FYOC to promote metabolic memory.