Effectiveness of Hybrid Closed-Loop Systems in Pediatric Type 1 Diabetes Mellitus Management: A Systematic Review

This systematic review synthesizes findings from 45 studies (2019-2024) on hybrid closed-loop (HCL) systems in pediatric type 1 diabetes (T1D). Consistent improvements in glycemic control were observed, with time-in-range (TIR, 70-180 mg/dL) increasing by 6.7-36.7 percentage points, particularly among patients transitioning from multiple daily injections. Adolescents benefited more than younger children (18.4% vs. 14.3% TIR increase, p=0.01), with nighttime control improving significantly (23.6% TIR increase, p<0.001). HbA1c reductions reached clinical significance in 68% of studies, and the likelihood of achieving HbA1c ≤6.5% tripled with HCL use (OR=3.03, p<0.001). Hyperglycemia (>250 mg/dL) decreased by up to 81%, while hypoglycemia (<70 mg/dL) showed modest but consistent reductions. Preliminary neurodevelopmental findings indicated improved brain structure metrics. However, disparities persist: only 30% of studies included underrepresented groups, and real-world data showed 21% lower HCL adoption in low-income populations. Device efficacy depended on usage patterns, with optimal TIR requiring ≥85% engagement in automated mode. Despite their transformative potential, HCL systems face challenges related to access and variability in response. Future research should focus on long-term outcomes, standardized metrics, and AI-driven personalization to enhance pediatric diabetes management.