Young Children Have Higher Variability of Insulin Requirements: Observations During Hybrid Closed-Loop Insulin Delivery

Klemen Dovc; Charlotte Boughton; Martin Tauschmann; Hood Thabit; Lia Bally; Janet M. Allen; Carlo L. Acerini; Sabine Arnolds; Carine de Beaufort; Richard M. Bergenstal; Fiona Campbell; Amy Criego; David B. Dunger; Daniella Elleri; Mark L. Evans; Elke Fröhlich-Reiterer; Sabine Hofer; Thomas Kapellen; Lalantha Leelarathna; Thomas R. Pieber; Birgit Rami-Merhar; Viral N. Shah; Judy Sibayan; Malgorzata E. Wilinska; Roman Hovorka

doi:10.2337/dc18-2625

Novel Communications in Diabetes

Young Children Have Higher Variability of Insulin Requirements: Observations During Hybrid Closed-Loop Insulin Delivery

Klemen Dovc¹,²,
Charlotte Boughton¹,
Martin Tauschmann¹,³,
Hood Thabit¹,⁴,
Lia Bally¹,⁵,
Janet M. Allen¹,⁶,
Carlo L. Acerini¹,⁶,
Sabine Arnolds⁷,
Carine de Beaufort⁸,
Richard M. Bergenstal⁹,
Fiona Campbell¹⁰,
Amy Criego⁹,
David B. Dunger¹,⁶,
Daniella Elleri¹¹,
Mark L. Evans¹,¹²,
Elke Fröhlich-Reiterer¹³,
Sabine Hofer¹⁴,
Thomas Kapellen¹⁵,
Lalantha Leelarathna⁴,
Thomas R. Pieber¹⁶,
Birgit Rami-Merhar³,
Viral N. Shah¹⁷,
Judy Sibayan¹⁸,
Malgorzata E. Wilinska¹,⁶ and
Roman Hovorka¹,⁶ ⇑,
on behalf of the APCam11, AP@Home, and KidsAP Consortia*

Corresponding author: Roman Hovorka, rh347{at}cam.ac.uk

¹Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.
²Department of Pediatric Endocrinology, Diabetes, and Metabolic Diseases, University Children’s Hospital, University Medical Centre, Ljubljana, Slovenia
³Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
⁴Manchester Diabetes Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester, U.K.
⁵Departments of Diabetes, Endocrinology, Clinical Nutrition, and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
⁶Department of Paediatrics, University of Cambridge, Cambridge, U.K.
⁷Profil Institut fuer Stoffwechselforschung GmbH, Neuss, Germany
⁸DECCP, Clinique Pédiatrique/CH de Luxembourg, Luxembourg, Luxembourg
⁹International Diabetes Center at Park Nicollet, St. Louis Park, MN
¹⁰Department of Paediatric Diabetes, Leeds Children’s Hospital, Leeds, U.K.
¹¹Royal Hospital for Sick Children, Edinburgh, U.K.
¹²Department of Diabetes and Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, U.K.
¹³Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
¹⁴Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
¹⁵Division for Paediatric Diabetology, University of Leipzig, Leipzig, Germany
¹⁶Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
¹⁷Barbara Davis Center for Diabetes, University of Colorado, Denver, CO
¹⁸Jaeb Center for Health Research, Tampa, FL

Diabetes Care 2019 Jul; 42(7): 1344-1347. https://doi.org/10.2337/dc18-2625

Abstract

OBJECTIVE To quantify age-related variability of insulin needs during day and night closed-loop insulin delivery.

RESEARCH DESIGN AND METHODS We retrospectively analyzed data from hybrid closed-loop studies involving young children (1–6 years old, n = 20), children (7–12 years, n = 21), adolescents (13–17 years, n = 15), and adults (>18 years, n = 58) with type 1 diabetes. The coefficient of variation quantified variability of insulin needs during 3 weeks of unrestricted-living hybrid closed-loop use.

RESULTS Data from 2,365 nights and 2,367 days in 114 participants were analyzed. The coefficient of variation of insulin delivery was higher in young children compared with adults (mean difference at nighttime 10.7 percentage points [95% CI 2.9–18.4], P = 0.003; daytime 6.4 percentage points [95% CI 2.0–10.9], P = 0.002) and compared with adolescents (mean difference at nighttime 10.2 percentage points [95% CI 0.0–20.4], P = 0.049; daytime 7.0 percentage points [95% CI 1.1–12.8], P = 0.014).

CONCLUSIONS Diabetes management in young children is complicated by higher variability in insulin requirements, supporting fast-track clinical practice adoption of closed-loop in this vulnerable population.

Footnotes

This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc18-2625/-/DC1.
↵* A list of the APCam11, AP@Home, and KidsAP Consortia investigators can be found in the Supplementary Data online.

Received December 24, 2018.
Accepted April 17, 2019.

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