What Drives Success with aHCL? Insights from MiniMed 780G Use
Martijn Vrouenraets, Stennie Zoet, Thomas Urgert, Bert-Jan van Beijnum, Henk-Jan Aanstoot, Peter van Dijk, Gozewijn Laverman
Determinants of optimal settings, user behavior, and patient characteristics. Oral presentation SO046, ATTD 2026, 11-14 March, Barcelona
Advanced Hybrid closed-loop systems such as the MiniMed™ 780G have substantially improved glycaemic outcomes in people with type 1 diabetes. However, outcomes still vary considerably between individuals. This raises an important clinical question: which factors actually determine success with these systems? Previous studies have suggested that optimal system settings and high SmartGuard use are associated with better glycaemic control. However, the relative contribution of these factors, as well as the role of user behaviour and patient characteristics, has remained unclear.
This multicentre study analysed data from adults with type 1 diabetes using the MiniMed 780G system, focusing on the impact of system settings, user behaviour, and patient characteristics on glycaemic outcomes. The study was conducted in collaboration between Ziekenhuisgroep Twente (ZGT), Isala Zwolle, and Diabeter NL / Diabeter Centre Amsterdam, combining expertise in clinical care, data analysis, and real-world diabetes technology use. CGM metrics were evaluated using multivariable regression analyses. The results were presented as an oral presentation at the ATTD 2026 congress in Barcelona. By combining data across centres, the study reflects real-world clinical practice across different care settings, strengthening the generalisability of the findings. Key variables included SmartGuard use, glucose target and active insulin time settings, bolus frequency, temporary target use, and patient characteristics such as age and sex.
KEY FINDINGS
- Combining optimal settings (glucose target 100 mg/dL and active insulin time 2 hours) with ≥95% SmartGuard use resulted in the highest time in range (TIR 76.5%), compared to 72.7% and 74.7% when only the optimal settings or the Smartguard criteria were met, respectively.
- This improvement in TIR was achieved without an increase in hypoglycaemia.
- SmartGuard use was a strong determinant of glycaemic outcomes, with TIR increasing by +5.7% per 10% increase in SmartGuard use.
- Bolus frequency had a major impact: users with >6 boluses/day achieved +15% higher TIR compared to <3/day.
- Use of optimal settings contributed independently (+3.2% TIR).
- Temporary target use was associated with lower TIR (−1.6% per hour/day).
- Age, sex, and system experience were not significantly associated with glycaemic outcomes.
These findings highlight that successful use of hybrid closed-loop systems depends not only on the technology itself, but on how it is used in daily life. In particular, consistent SmartGuard use and active engagement through frequent bolusing appear to be key drivers of optimal outcomes. The results underline the growing importance of real-world evidence in advancing diabetes technology. For clinical practice, the results emphasise the need for structured education, behavioural support, and optimisation of system settings to help people achieve the full benefits of advanced systems.
CONCLUDING THE AUTHORS STATE
"The best glycemic control with the MiniMed 780G system is achieved through a comprehensive approach combining optimal settings, prolonged SmartGuard use, frequent bolusing, and appropriate temporary target use." -
Please click here to go to the oral presentation.