Insulin delivery and nocturnal glucose control in children and adolescents with type 1 diabetes

Abstract

Introduction: Nocturnal glucose control remains challenging in children and adolescents with type 1 diabetes due to highly variable overnight insulin requirements. The issue may be addressed by glucose responsive insulin delivery based on real-time continuous glucose measurements.Areas covered: This review outlines recent developments of glucose responsive insulin delivery systems from a paediatric perspective. We cover threshold-based suspend application, predictive low glucose suspend, and more advanced single hormone and dual-hormone closed-loop systems. Approaches are evaluated in relation to nocturnal glucose control particularly during outpatient randomised controlled trials.Expert opinion: Significant progress translating research from controlled clinical centre settings to free-living unsupervised home studies have been achieved over the past decade. Nocturnal glycaemic control can be improved whilst reducing the risk of hypoglycaemia with closed-loop systems. Following the US regulatory approval of the first hybrid closed-loop system in non-paediatric population, large multinational closed-loop clinical trials and pivotal studies including paediatric populations are underway or in preparation to facilitate the use of closed-loop systems in clinical practice.

Updates and advances in technology for diabetes self-management

“…This feature automatically stops the flow of insulin for a set time period (usually up to 2 h) once a patient's glucose enters (or is trending toward) the patient-specific hypoglycemia threshold, thereby decreasing the risk of serious hypoglycemic events, especially nocturnal hypoglycemia. 56 From here, technology has advanced further with approval of the Medtronic 670G system, the first hybrid closed-loop system for people with type 1 diabetes. The pump is paired with the Guardian CGM Sensor and is capable of a function called "auto mode."…”

Lower plasma insulin levels during overnight closed-loop in school children with type 1 diabetes: Potential advantage? A randomized cross-over trial

“…Technical developments in closing the loop between the glucose sensor data and insulin administration (so called „artificial pancreas“) should improve metabolic outcome and reduce burden for the pediatric patient and his family. Several studies have shown that overnight closed-loop insulin delivery can improve glucose control and reduce the risk of hypoglycemia in young patients with type 1 diabetes [9,10,11]. As a more targeted insulin administration has been associated with lower insulin doses and plasma insulin levels in adolescents [12,13] to date only scarce data is available for a pediatric population [14].…”