Insights for personalized choice of a hybrid closed–loop system: an expert opinion

Hybrid closed-loop (HCL) systems have transformed diabetes management by integrating continuous glucose monitoring (CGM) with insulin pumps and algorithm-driven insulin dosing. In type 1 diabetes, randomized controlled trials and meta-analyses consistently demonstrate increased time in range and reduced HbA1c with HCL compared to other insulin treatments, without an increased risk of hypoglycemia. Benefits have also been reported in individuals with type 2 diabetes, in pregnant women, and across other groups of persons with diabetes (PWDs). As multiple HCL systems become available, tailoring the choice to clinical profiles and patient preferences can help optimize system selection. This expert paper discusses pump, CGM device and whole system features, supporting evidence from the literature, and other factors to guide the personalized selection of HCL systems currently available in Italy. Practical examples of sound alignment between device features and patient needs/preferences are also provided. The result is a patient-centered framework that combines device features, clinical needs, lifestyle, and preferences to support shared decision-making and ultimately improve outcomes and quality of life for PWDs.