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Peer-reviewedCC BY-NC 4.0Diabetes, Obesity & Metabolism

Dose‐Normalised Time in Range (dn‐TIR) Improves Following Hybrid Closed‐Loop (HCL) Therapy in Type 1 Diabetes: A Real‐World Cohort Study From Australia and the United Kingdom

  • Jude Wellens‐Mensah1,2
  • Akash Konantambigi3
  • Keimee Lopez1,2
  • Jessica Triay4
  • Vasant Shenoy3,5
  • Gaurav Puri6
  • Emma Wilmot7,8
  • Thozhukat Sathyapalan1,2
  • Harshal Deshmukh3,4
8 affiliations
  1. 1Hull University Teaching Hospitals NHS Trust Hull UK
  2. 2Hull York Medical School University of Hull Hull UK
  3. 3College of Medicine and Dentistry James Cook University Townsville Queensland Australia
  4. 4Gold Coast University Hospital Gold Coast Queensland Australia
  5. 5Townsville University Hospital Townsville Queensland Australia
  6. 6Logan Hospital, Metro South Health Logan Queensland Australia
  7. 7University Hospitals of Derby and Burton NHS Foundation Trust Derby UK
  8. 8University of Nottingham Nottingham UK
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Abstract

Objective: To evaluate dose‐normalised time in range (dn‐TIR) and its log relative change (Δdn‐TIR) as measures of within‐person glycaemic change relative to total daily insulin exposure following hybrid closed‐loop therapy (HCL/AID).

Research Design and Methods: We conducted a retrospective two‐cohort study of people with type 1 diabetes commencing hybrid closed‐loop/automated insulin delivery (HCL/AID) therapy in Australia and the United Kingdom (UK). dn‐TIR was calculated as time in range (TIR) 3.9–10.0 mmol/L (70–180 mg/dL) divided by total daily insulin dose (TDD) and Δdn‐TIR as log[(TIR/TDD)post/(TIR/TDD)pre].

Results: The study comprised 86 people living with type 1 diabetes in Australia and 288 in the UK. In the fixed Australian dn‐TIR cohort, TIR increased from 53.2% ± 20.7% to 70.4% ± 14.6% (n = 86; p < 0.001), whereas mean TDD changed from 53.3 to 52.0 units/day (n = 86; p = 0.724). Median Δdn‐TIR was 0.224 [IQR: −0.033, 0.583]. In the UK cohort, TIR increased from a median 54% [34, 68] to 66% [54, 74] (n = 257; p < 0.001), whereas mean TDD changed from 44.1 to 46.3 units/day (n = 242; p = 0.152). Median Δdn‐TIR was 0.194 [IQR: −0.097, 0.541].

Conclusions: HCL/AID therapy improved TIR relative to TDD in two real‐world cohorts. dn‐TIR and Δdn‐TIR are not replacements for established CGM metrics or direct measures of insulin sensitivity; they may provide an adjunct longitudinal description of whether glycaemic improvement was accompanied by proportionately greater, similar or lower insulin exposure.

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Cite

BibTeXRIS
BibTeX
@article{wellensmensah2026dosenormalised,
  title = {{Dose‐Normalised Time in Range (dn‐TIR) Improves Following Hybrid Closed‐Loop (HCL) Therapy in Type 1 Diabetes: A Real‐World Cohort Study From Australia and the United Kingdom}},
  author = {Jude Wellens‐Mensah and Akash Konantambigi and Keimee Lopez and Jessica Triay and Vasant Shenoy and Gaurav Puri and Emma Wilmot and Thozhukat Sathyapalan and Harshal Deshmukh},
  journal = {Diabetes, Obesity \& Metabolism},
  year = {2026},
  month = sep,
  doi = {10.1111/dom.71342},
  url = {https://doi.org/10.1111/dom.71342},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Dose‐Normalised Time in Range (dn‐TIR) Improves Following Hybrid Closed‐Loop (HCL) Therapy in Type 1 Diabetes: A Real‐World Cohort Study From Australia and the United Kingdom
AU  - Jude Wellens‐Mensah
AU  - Akash Konantambigi
AU  - Keimee Lopez
AU  - Jessica Triay
AU  - Vasant Shenoy
AU  - Gaurav Puri
AU  - Emma Wilmot
AU  - Thozhukat Sathyapalan
AU  - Harshal Deshmukh
PY  - 2026
DA  - 2026/09/09
JO  - Diabetes, Obesity & Metabolism
DO  - 10.1111/dom.71342
UR  - https://doi.org/10.1111/dom.71342
AB  - Objective: To evaluate dose‐normalised time in range (dn‐TIR) and its log relative change (Δdn‐TIR) as measures of within‐person glycaemic change relative to total daily insulin exposure following hybrid closed‐loop therapy (HCL/AID).  Research Design and Methods: We conducted a retrospective two‐cohort study of people with type 1 diabetes commencing hybrid closed‐loop/automated insulin delivery (HCL/AID) therapy in Australia and the United Kingdom (UK). dn‐TIR was calculated as time in range (TIR) 3.9–10.0 mmol/L (70–180 mg/dL) divided by total daily insulin dose (TDD) and Δdn‐TIR as log[(TIR/TDD)post/(TIR/TDD)pre].  Results: The study comprised 86 people living with type 1 diabetes in Australia and 288 in the UK. In the fixed Australian dn‐TIR cohort, TIR increased from 53.2% ± 20.7% to 70.4% ± 14.6% (n = 86; p < 0.001), whereas mean TDD changed from 53.3 to 52.0 units/day (n = 86; p = 0.724). Median Δdn‐TIR was 0.224 [IQR: −0.033, 0.583]. In the UK cohort, TIR increased from a median 54% [34, 68] to 66% [54, 74] (n = 257; p < 0.001), whereas mean TDD changed from 44.1 to 46.3 units/day (n = 242; p = 0.152). Median Δdn‐TIR was 0.194 [IQR: −0.097, 0.541].  Conclusions: HCL/AID therapy improved TIR relative to TDD in two real‐world cohorts. dn‐TIR and Δdn‐TIR are not replacements for established CGM metrics or direct measures of insulin sensitivity; they may provide an adjunct longitudinal description of whether glycaemic improvement was accompanied by proportionately greater, similar or lower insulin exposure.
SN  - 1462-8902
SN  - 1463-1326
ER  -