Youth and young adults with type 1 diabetes are well recognised as being at additional risk for the development of very unhealthy glucose control. Compounding this, in those struggling with diabetes, traditional management options often fail to reduce disease burden and restore glucose levels to within target ranges. However, in recent years diabetes technology has rapidly advanced. Advanced diabetes technology now offers the promise of a paradigm shift in how those struggling with the burdens of diabetes management can be treated. This talk discusses the evidence for advanced hybrid closed loop at this complex life stage, and proposes that those experiencing the most burden may often have the most to gain from closed loop therapy.