Background: Although comparable in their overall structure, hybrid closed loop (HCL) systems show meaningful differences in components, type of algorithm, modifiable settings, and additional features. Through this network meta-analysis, we aimed to compare efficacy and safety of the different HCL systems in people with diabetes. Methods: We searched MEDLINE, EMBASE, CENTRAL and PubMed for randomized clinical trials enrolling children, adolescents and/or adults with type 1 or type 2 diabetes, evaluating Minimed 670G, Minimed 780G, Control-IQ, CamAPS Fx, DBLG-1, DBLHU, and Omnipod 5 HCL systems against other types of insulin therapy, and reporting time in target range (TIR) as outcome. Results: A total of 28 trials, all enrolling people with type 1 diabetes, were included. HCL systems significantly increased TIR compared to subcutaneous insulin therapy without continuous glucose monitoring (SIT). Minimed 780G achieved the highest TIR ahead of Control IQ (mean difference (MD) 5.1%, 95% confidence interval (95% CI) [0.68; 9.52], low certainty), Minimed 670G (MD 7.48%, 95%CI [4.27; 10.7], moderate certainty), CamAPS Fx (MD 8.94%, 95%CI [4.35; 13.54], low certainty), and DBLG1 (MD 10.69%, 95%CI [5.73; 15.65], low certainty). All HCL systems decreased time below target range, with DBLG1 (MD -3.69%, 95%CI [-5.2; -2.19], high certainty), Minimed 670G (MD -2.9%, 95%CI [-3.77; -2.04], moderate certainty) and Minimed 780G (MD -2.79%, 95%CI [-3.94; -1.64], high certainty) exhibiting the largest reductions compared to SIT. Risk of severe hypoglycemia and diabetic ketoacidosis was similar to other types of insulin therapy. Conclusions: For the first time we show a hierarchy of efficacy among the different HCL systems in people with type 1 diabetes, thus providing support to clinical decision-making.