Skip to content
type1.science
Phase 3CompletedNCT04235504

ADAPT: MiniMed 780G advanced hybrid closed-loop vs injections + flash CGM

A European randomized trial showing that switching adults with poorly controlled type 1 diabetes from insulin injections plus flash glucose monitoring to the MiniMed 780G automated insulin delivery system cut HbA1c by about 1.4% and added roughly 6.6 hours/day in target range at 6 months, with gains sustained at 12 months.

Primary endpoints

  • Between-group difference in mean HbA1c change from baseline to 6 months (advanced hybrid closed-loop vs. injections plus flash CGM, cohort A)
  • Within-group change in mean HbA1c between 6 and 12 months in the continuation phase (superiority in the group switched to AHCL; noninferiority in the group continuing AHCL)

Results so far

Yes, results were reported and peer-reviewed. At 6 months, average HbA1c fell from 9.00% to 7.32% on the MiniMed 780G (a 1.54% drop) versus a 0.20% drop (9.07% to 8.91%) on injections plus flash CGM, a model-based between-group difference of -1.42% (95% CI -1.74 to -1.10; p<0.0001). About 27.8% of 780G users reached an HbA1c below 7% versus none in the injection group, and time in range rose by about 27.6 percentage points (roughly 6.6 more hours per day in target) without more low-glucose time. No diabetic ketoacidosis, severe hypoglycemia, or serious device-related adverse events occurred in the study phase. In the 12-month continuation, participants switched to the system dropped HbA1c by a further 1.4% (8.9% to 7.5%), and those who stayed on it held their gains (noninferior, +0.1%).

The full picture

What this trial tested and why it matters

ADAPT asked a practical question: if you have type 1 diabetes and your glucose is running high despite doing "everything right" with insulin injections, does switching to an automated insulin delivery (AID) system actually help? It compared the MiniMed 780G advanced hybrid closed-loop system — an insulin pump that automatically adjusts insulin every few minutes based on a continuous glucose sensor — against staying on multiple daily injections plus a flash glucose monitor.1 This matters because most earlier AID trials enrolled people who were already fairly well controlled, leaving open whether the technology helps those who struggle most.1

Who it was for

The trial enrolled adults (18 and older) who had lived with type 1 diabetes for at least 2 years, were using injections plus a flash or real-time CGM, and still had an HbA1c of at least 8.0% — a marker of suboptimal control.2 On average, participants were checking their sensor about 9 times a day yet remained above target, so this was not a group that lacked effort or engagement.3

How it was designed

ADAPT was a prospective, multicentre, open-label randomized controlled trial run at 14 centres in France, Germany, and the UK.1 In the main group (cohort A), 82 adults were randomly assigned 1:1 — 41 to the 780G system and 41 to continue injections plus flash CGM — for a 6-month study phase, followed by a 6-month continuation phase in which the injection group also switched to the system.1 The main outcome was the difference in HbA1c change at 6 months.4

Key results

At 6 months, average HbA1c fell from 9.00% to 7.32% on the 780G (a 1.54% drop) versus essentially no change on injections (9.07% to 8.91%), a between-group difference of -1.42% (95% CI -1.74 to -1.10; p<0.0001).1 About 27.8% of system users reached an HbA1c below 7%, compared with none on injections, and time in target range rose by roughly 27.6 percentage points — about 6.6 more hours per day in range — without more low-glucose time.3 No diabetic ketoacidosis, severe hypoglycemia, or serious device-related events occurred in the study phase.1 At 12 months, the people who switched gained a further 1.4% HbA1c reduction, and those who stayed on the system held their improvement.5

What it means and what's next

ADAPT provides strong evidence that AID benefits the people who are hardest to control, not just those already near target, supporting earlier and wider access to closed-loop therapy.1 As an industry-sponsored, open-label study its participants knew their assignment, so real-world and longer-term confirmation remains valuable.4

References

  1. Choudhary P, Kolassa R, Keuthage W, et al. Advanced hybrid closed loop therapy versus conventional treatment in adults with type 1 diabetes (ADAPT): a randomised controlled study. Lancet Diabetes Endocrinol (2022). https://doi.org/10.1016/S2213-8587%2822%2900212-1 ↩ ↩2 ↩3 ↩4 ↩5 ↩6 ↩7

  2. ClinicalTrials.gov. Advanced Hybrid Closed Loop Study in Adult Population With Type 1 Diabetes (ADAPT), NCT04235504. ClinicalTrials.gov (2023). https://clinicaltrials.gov/study/NCT04235504 ↩

  3. Medtronic. ADAPT study results published in The Lancet Diabetes & Endocrinology show improved glycemic control and treatment satisfaction among those using MiniMed 780G system, compared to insulin injections. Medtronic News (2022). https://news.medtronic.com/2022-09-01-Medtronic-ADAPT-study-results-published-in-The-Lancet-Diabetes-Endocrinology-show-improved-glycemic-control-and-treatment-satisfaction-among-those-using-MiniMed-TM-780G-system-,-compared-to-insulin-injections ↩ ↩2

  4. Choudhary P, et al. Advanced hybrid closed loop therapy versus conventional treatment in adults with type 1 diabetes (ADAPT). Lancet Diabetes Endocrinol via PubMed, PMID 36058207 (2022). https://pubmed.ncbi.nlm.nih.gov/36058207/ ↩ ↩2

  5. Edd SN, Castañeda J, Choudhary P, et al. Twelve-month results of the ADAPT randomized controlled trial: reproducibility and sustainability of advanced hybrid closed-loop therapy outcomes versus conventional therapy in adults with type 1 diabetes. Diabetes Obes Metab (2023). https://doi.org/10.1111/dom.15217 ↩