Priorities, Expectations, Perceptions of Time in Tight Range and Support Needs Relating to Closed-Loop Therapy Among Adults With Type 1 Diabetes: The SELECT HCL Study.

AIMS: To assess factors influencing closed-loop system choice, perceptions of treatment satisfaction and glycaemic targets, perceived benefits and expectations of therapy, and support needs among adults with Type 1 diabetes (T1D) using, awaiting initiation of or considering closed-loop therapy. MATERIALS AND METHODS: SELECT HCL was a cross-sectional survey study conducted at a specialist secondary care diabetes service between September 2025 and February 2026. Adults with T1D completed an anonymous online questionnaire assessing experiences and perspectives relating to closed-loop therapy. Descriptive, subgroup, and multivariable logistic regression analyses were performed. RESULTS: Overall, 166 participants were included (median age 47 years; HbA1c 52 mmol/mol [6.9%]). Sensor accuracy (39.3%), glycaemic performance (37.6%) and patch pump without tubing (27.5%) were the most commonly prioritised factors when selecting sensors, algorithms and insulin pumps, respectively. Treatment satisfaction priorities differed by age (p = 0.006), with younger participants more frequently prioritising reduction in burden and quality of life (QoL), whereas older participants prioritised hypoglycaemia-related outcomes. Although 63.8% perceived time in tight range (TITR, 3.9-7.8 mmol/L) ≥ 50% as beneficial for their health, only 36.1% considered it an achievable target. Most participants reported that closed-loop therapy improved QoL (78.6%), reduced hyperglycaemia (75.0%) and hypoglycaemia (72.3%), and met expectations (81.1%). Adequate support during closed-loop initiation was associated with therapy meeting participants' expectations (OR 16.6, 95% CI 5.0-52.4, p < 0.001). CONCLUSIONS: Adults with T1D reported diverse priorities and experiences relating to closed-loop therapy, extending beyond glycaemic outcomes alone. Adequate support during closed-loop initiation may represent an important component of successful implementation in routine clinical care.