Closed-Loop Insulin Therapy Improves Glycemic Control in Children Aged <7 Years
A randomized controlled trial
- Andrew Dauber, MD, MMSC1,
- Liat Corcia, MD2,
- Jason Safer, BS1,
- Michael S.D. Agus, MD1,3,
- Sara Einis, MSN4 and
- Garry M. Steil, PHD3⇓
- 1Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
- 2Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
- 3Medicine Critical Care Program, Boston Children’s Hospital, Boston, Massachusetts
- 4Department of Nursing, Boston Children’s Hospital, Boston, Massachusetts
- Corresponding author: Garry M. Steil, .
OBJECTIVE To assess the possibility of improving nocturnal glycemic control as well as meal glycemic response using closed-loop therapy in children aged <7 years.
RESEARCH DESIGN AND METHODS This was a randomized controlled crossover trial comparing closed-loop with standard open-loop insulin pump therapy performed in an inpatient clinical research center. Ten subjects aged <7 years with type 1 diabetes for >6 months treated with insulin pump therapy were studied. Closed-loop therapy and standard open-loop therapy were compared from 10:00 p.m. to 12:00 p.m. on 2 consecutive days. The primary outcome was plasma glucose time in range (110–200 mg/dL) during the night (10:00 p.m.–8:00 a.m.). Secondary outcomes included peak postprandial glucose levels, incidence of hypoglycemia, degree of hyperglycemia, and prelunch glucose levels.
RESULTS A trend toward a higher mean nocturnal time within target range was noted for closed versus open-loop therapy, although not reaching statistical significance (5.3 vs. 3.2 h, P = 0.12). There was no difference in peak postprandial glucose or number of episodes of hypoglycemia. There was significant improvement in time spent >300 mg/dL overnight with closed-loop therapy (0.18 vs. 1.3 h, P = 0.035) and the total area under the curve of glucose >200 mg/dL (P = 0.049). Closed-loop therapy returned prelunch blood glucose closer to target (189 vs. 273 mg/dL on open loop, P = 0.009).
CONCLUSIONS Closed-loop insulin delivery decreases the severity of overnight hyperglycemia without increasing the incidence of hypoglycemia. The therapy is better able to reestablish target glucose levels in advance of a subsequent meal. Younger children with type 1 diabetes may reap significant benefits from closed-loop therapy.
- Received June 7, 2012.
- Accepted July 29, 2012.
- © 2012 by the American Diabetes Association.
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