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

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ABSTRACT 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.