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

Dovc, Klemen; Boughton, Charlotte; Tauschmann, Martin; Thabit, Hood; Bally, Lia; Allen, Janet M.; Acerini, Carlo L.; Arnolds, Sabine; de Beaufort, Carine; Bergenstal, Richard M.; Campbell, Fiona; Criego, Amy; Dunger, David B.; Elleri, Daniella; Evans, Mark L.; Fröhlich-Reiterer, Elke; Hofer, Sabine; Kapellen, Thomas; Leelarathna, Lalantha; Pieber, Thomas R.; ... (2019). Young Children Have Higher Variability of Insulin Requirements: Observations During Hybrid Closed-Loop Insulin Delivery. Diabetes care, 42(7), pp. 1344-1347. American Diabetes Association 10.2337/dc18-2625

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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.

With increasing application of insulin pump therapy and continuous glucose monitors, hybrid closed-loop has become a feasible treatment modality for people with type 1 diabetes (1,2). Apart from manual meal-time boluses, insulin delivery is autonomously modulated by a control algorithm based on real-time sensor glucose values. Insulin delivery may vary considerably from day to day and night to night due to varying activity levels, insulin set-changes, meal timings and composition, and other factors(3,4).Todate,theassociationbetweenageandinsulinvariabilityhasnotbeen assessed.Inthepresentanalysis,weinvestigatewhetherinsulinrequirementsmaybe more variable in younger age.

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