ADAPT: MiniMed 780G advanced hybrid closed-loop vs injections + flash CGM
What this study tests
European randomized trial in adults with T1D and HbA1c at least 8% using injections plus flash CGM. MiniMed 780G lowered HbA1c by an adjusted 1.42 percentage points more than continued injections at six months; the 12-month extension supported persistence of the benefit.
Editorial review: .
Registry checked: 2026-09-17. Registry’s own update: 2023-03-27.
Most recent recorded citation date: 2023-08-08. Only explicit date metadata is included; an undated citation may be newer. This does not mean every claim was reviewed on that date.
Trial status, labels and access can change between reviews. How we review the evidence · How to read the evidence
Evidence at a glance
- Who can enter the study?
- Adults at least 18 years old with type 1 diabetes for at least 2 years, an HbA1c of at least 8.0% (suboptimal control), already managing on multiple daily injections plus a flash or real-time CGM for at least 3 months, with daily insulin needs of roughly 8 to 250 units. Registered eligibility ↗Enrollment criteria describe who may enter. They do not establish who was analyzed or the denominator for a reported result.
- Reported benefit and results
- Yes, results were reported and peer-reviewed. At 6 months, average HbA1c fell from 9.00% to 7.32% on the MiniMed 780G and from 9.07% to 8.91% on injections plus flash CGM. The publication reports mean individual changes of -1.54 and -0.20 percentage points, respectively; these are not simple subtractions of the displayed group means. The 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%).Read the result sources and their limitations →
- Important harms
- Read the reported results, safety discussion and original sources. A separate harms summary is not available; this does not establish safety.
- Research access and approval
- Study regions: United Kingdom, European Union. A trial listing does not establish product approval or current recruitment at a particular site. Check the study’s current entry requirements.
- What remains uncertain?
- Read the full discussion and original sources for study limitations. Planned endpoints and completion dates are not results.
Research status alone does not establish approval, clinical benefit or local availability. This record cites company or conference reports. Those sources may describe interim findings; their source type is shown in the source list.
Primary endpoints
- Between-group difference in HbA1c change from baseline to six months in cohort A. The 12-month continuation was a separate extension analysis.
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 versus 9.07% to 8.91% on injections. The abstract separately reports mean changes of -1.54 and -0.20 percentage points; these should not be presented as the arithmetic differences between the displayed group means. The model-based between-group difference was 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 can benefit adults whose glucose remains above target on injections, 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
Sources
- [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) · Peer-reviewed study
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).
- [2]ClinicalTrials.gov. Advanced Hybrid Closed Loop Study in Adult Population With Type 1 Diabetes (ADAPT), NCT04235504. *ClinicalTrials.gov* (2023) · Trial registry
ClinicalTrials.gov. Advanced Hybrid Closed Loop Study in Adult Population With Type 1 Diabetes (ADAPT), NCT04235504. ClinicalTrials.gov (2023).
- [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) · Manufacturer
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).
- [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) · Peer-reviewed study
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).
- [5]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. · Peer-reviewed study · 2023-08-08
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).