Closed-Loop Insulin Delivery in Children <7 Years of Age

Closed-Loop Insulin Therapy (CLT)

Background

• Children at increased risk of hypoglycemia, especially at night

• Neurocognitive effects can result

• Children have unpredictable eating patterns and erratic activity levels

• by insulin pump

Closed-Loop Insulin Delivery in Children <7 Years of Age

Objective

•The aim of CLT is to achieve tight glucose control and reduce risk of hypoglycemia

•CLT combines glucose sensing and insulin-delivery components with real-time glucose-responsive insulin administration

- Disposable sensor measures interstitial glucose levels- Algorithm controls rapid-acting insulin analog delivery

•The aim of this study as to test CLT in young children with diabetes

Closed-Loop Insulin Delivery in Children <7 Years of Age

• Children <7 years with T1DM >6 months treated with insulin pump therapy for >6 weeks (n=10)

• Randomized crosss-over trial comparing CLT with open-loop therapy

• Two control periods: overnight and daytime

• Target blood glucose: 10 PM-6 AM – 150 mg/dL; 6 AM-noon – 120 mg/dL

Design and Methods

Closed-Loop Insulin Delivery in Children <7 Years of Age

Study Design

Closed-Loop Insulin Delivery in Children <7 Years of Age

Results

• Time at night target increased with CLT but not significantly different from open-loop

• Time in overnight extreme hyperglycemia and total glycemic excursion significantly reduced

• No difference in number of interventions for hypoglycemia

Closed-Loop Insulin Delivery in Children <7 Years of Age

Closed-Loop Insulin Delivery in Children <7 Years of Age

Conclusions

• CLT decreased the degree of noturnal hyperglycemia in young children without increasing the incidence of hypoglycemia

• CLT improved prelunch blood glucose

• CLT has the potential to improve diabetes care in very young children