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Artificial pancreas shows promise for young children
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PHILDELPHIA — Closed-loop insulin therapy appeared to boost nocturnal glycemic control in children with diabetes aged younger than 7 years when compared with standard pump therapy, according to data from a late-breaking abstract presented here at the American Diabetes Association’s 72nd Scientific Sessions.
Andrew Dauber, MD, MMSc, of the division of endocrinology at Boston Childrens Hospital, and colleagues said young children with diabetes have unique issues that complicate management and closed-loop insulin therapy, or artificial pancreas, demonstrated promise for improving glycemic control this patient population.
“Young children have increased rates of hypoglycemia, and in particular, nocturnal hypoglycemia. Second, there’s a concern that these repeated episodes of hypoglycemia can result in neurocognitive effects. Additionally, kids have unpredictable eating patterns,” Dauber said during a presentation.
Dauber and colleagues performed a randomized, controlled clinical trial comparing closed-loop therapy with standard pump therapy in children with diabetes. To qualify for inclusion, patients had to be aged younger than 7 years, have had a diagnosis of type 1 diabetes for more than 6 months; had been treated with an insulin pump for more than 6 weeks; and have no significant medical problems except for celiac disease.
Ten children were included in the study. They ranged in age from 2 to 6.8 years, with a mean age of 5.1 years. The duration of diabetes ranged from 6 months to 4.7 years, with a mean duration of 2.1 years. HbA1c ranged from 7.1% to 8.9%, with a mean of 8.1%, Dauber said.
The patients’ average daily insulin intake was administered at 0.61 units/kg to 1 units/kg. For 48 hours, children were admitted to a research unit and given the same meals each day.
Measurements of closed-loop therapy and standard pump therapy were compared from 10 p.m. to 12 p.m. in random order, Dauber said. Closed-loop therapy insulin rates were adjusted every minute from 8 a.m. to 12 p.m. and every 20 minutes from 10 p.m. to 8 a.m. based on continuous glucose monitoring (Abbott Navigator) data.
Glucose targets were 150 mg/dL (10 p.m. to 6 a.m.) and 120 mg/dL. According to the data, closed-loop therapy increased nighttime time-in-target (P=.16), while reaching similar postprandial peak levels, as compared with standard pump therapy (P=.9). During the open-loop, there were four interventions vs. five interventions during closed-loop therapy (P=1).
The target for treated patients was 150 mg/dL (10 p.m. to 6 a.m.) and 120 mg/dL (6 a.m. to 12 p.m.).
“Closed-loop therapy decreased the degree of nocturnal hyperglycemia in young children without increasing incidence of hypoglycemia. Closed-loop therapy improved pre-lunch blood sugars and closed-loop therapy has the potential to improve diabetes care for very young children. We believe that this is an underrepresented group in research studies and that they need dedicated research in the development of an artificial pancreas,” Dauber concluded.
For more information:
- Dauber A. Abstract #153-LB. Presented at: the American Diabetes Association’s 72nd Scientific Sessions Meeting. June 8-12, 2012; Philadelphia
Disclosures:
- Dr. Dauber reports no relevant financial disclosures. Abbott Diabetes Care, Animas Corporation and Hemocue Inc. provided supplies for this study, but played no role in the study’s design.