Trial of Closed-Loop therapy in Young Children with Type 1 Diabetes

In this multicenter, randomized, crossover trial, we recruited children 1 to 7 years of age with type 1 diabetes who were receiving insulin-pump therapy.  Participants received treatment in two 16-week periods, in random order, in which the closed-loop system was compared with sensor-augmented pump therapy.

The primary end point was between-treatment difference in the percentage of time that the sensor glucose measurement was in the target range (70 to 180 mg per deciliter) during each 16-week period. The secondary end points included the percentage of time spent in a hyperglycemic state (glucose level, >180 mg per deciliter), the glycated hemoglobin level, the mean sensor glucose level, and the percentage of time spent in a hypoglycemic state (glucose level, <70 mg per deciliter).

A total of 74 participants underwent randomization. The mean (±SD) age of the participants was 5.6±1.6 years, and the baseline glycated hemoglobin level was 7.3±0.7%. The percentage of time with the glucose level in the target range was 8.7 percentage points .The mean adjusted difference in the percentage of time spent in a hyperglycemic state was −8.5 percentage points .The difference in the glycated hemoglobin level was −0.4 percentage points .And the sensor glucose mean difference level was −12.3 mg per deciliter.The median time spent in the closed-loop mode was 95% over the 16-week closed-loop period.

Therefore a hybrid closed-loop system significantly improved glycemic control in very young children with type 1 diabetes, without increasing the time spent in hypoglycemia.