Closing the Loop on Managing Youth With Type 1 Diabetes: Children Are Not Just Small Adults

Abstract

As hybrid closed-loop (HCL) insulin delivery systems permeate clinical practice, it is critical to ensure all with diabetes are afforded the opportunity to benefit from this technology. Indeed, due to the suboptimal control achieved by the vast majority of youth with type 1 diabetes (T1D), pediatric patients are positioned to see the greatest benefit from automated insulin delivery systems. To ensure these systems are well poised to deliver the promise of more targeted control, it is essential to understand the unique characteristics and factors of childhood. Herein, the developmental and physiological needs of youth with T1D are reviewed and consideration is given to how HCL could address these issues. Studies of HCL technologies in youth are briefly reviewed. As future-generation closed-loop systems are being devised, features that could make this technology more attractive to youth and to their families are discussed. Integration of HCL has the potential to minimize the burden of this chronic medical condition while improving glycemic control and ultimately allowing our pediatric patients to fulfill the primary goal of childhood, to be a kid.

Figure 1

Four nights (12 a.m.–7 a.m.) in a single patient using the 670G system. In each panel, sensor glucose tracing is represented as the black line, with the system set point of 120 mg/dL (6.7 mmol/L) denoted by the solid green line. The target range of 70–180 mg/dL (3.9–10 mmol/L) is shaded in light green. The lower panel displays in pink the variable automated basal insulin delivery (Auto-basal) that is driven by the sensor glucose values. Carbs, carbohydrates; temp, temporary; U, units.

Figure 2

Comparison of time in target ranges during the 2-week run-in phase using open-loop pump settings to data from the 3-month HCL period for pediatric participants (aged 7–13 years old) in the 670G trial (30).