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

• DOI: 10.2337/dc18-2625
• Publication Date: 2019-06-14T19:52:11Z
• Authors: Klemen Dovc; Charlotte Boughton; Martin Tauschmann; Hood Thabit; Lia Bally; Janet M. Allen; Carlo L. Acerini; Sabine Arnolds; Carine de Beaufort; Richard M. Bergen...; Fiona Campbell; Amy Criego; David B. Dunger; Daniella Elleri; Mark L. Evans; Elke Fröhlich-Rei...; Sabine Hofer; Thomas Kapellen; Lalantha Leelarathna; Thomas R. Pieber; Birgit Rami-Merhar; Viral N. Shah; Judy Sibayan; Malgorzata E. Wil...; Roman Hovorka; ; Klemen Dovc; Martin Tauschmann; Charlotte Boughton; Gianluca Musolino; Hood Thabit; Lia Bally; Sonja Slegtenhorst; Janet M. Allen; Malgorzata E. Wil...; Yue Ruan; Josephine Hayes; Nicole Barber; Jane Curtis; Carlo L. Acerini; David B. Dunger; Mark L. Evans; Roman Hovorka; Lalantha Leelarathna; Hood Thabit; Angel Shaju; Stefanie Yau; Linda James; Karthirani Balakr...; Denise Donahue; Womba Mubita; Jane Exall; James Yong; Rachel Forshaw; Rebecca Pad; Stephanie Heath; Emily Metcalfe; Fiona Campbell; Judy Sibayan; Craig Kollman; Peiyao Cheng; Roy W. Beck; John Lum; Sarah Borgman; Viki Huegel; Sydnee Bradshaw; Amanda Hellman; Nanadan Patibandla; Chris McCarthy; Carlos Murphy; Brian Bugielski; Barvan Alvarado; Daniella Elleri; Morag McDonald; Louise Bath; Harriet Miles; Debbie Miller; Emily Collett; Julie Baggott; Key Riding; Jane Thomson; Richard M. Bergen...; Amy Criego; Anders B. Carlson; Thomas Martens; Shannon Beasley; M. Madden; Beth Olson; Jamie Hyatt; Charlotte Ashanti; Vera Mikityuk; LeeAnn Thomas; Wanda Konerza; Viral N. Shah; Hal Joseph; Christie R. Beatson; Jamie K. Demmitt; Prakriti Joshee; Dawn White; Harald Kojzar; Julia K. Mader; Elisabeth Suppan; Thomas R. Pieber; Erike E. Fröhlich...; Martin Ellmerer; Manuel Holzer; Dominique Schaeffer; Muriel Fichelle; Ulrike Schierloh; Carine de Beaufort; Alena G. Thiele; Heike Bartelt; Thomas M. Kapellen; Daniela Abt; Dagmar Meraner; Elisabeth Binder; Elisabeth Steichen; Lukas Hackl; Sabine Hofer; Birgit Rami Merhar; Maria Fritsch; Katrin Nagl; Sonja Katzenbeiss...; Martin Tauschmann; Sabine Arnolds; Carsten Benesch; Sibylle Dellweg; Martina Haase; Lutz Heinemann; Kirstin Kuschma; Maren Luebkert; Elke Przetak; Krisztina Schmitz...
• Keywords: Adult; Blood Glucose; Male; Adolescent; Individuality; Multicenter Studies as Topic/statistics & numerical data; Young Adult; 03 medical and health sciences; Blood Glucose/drug effects; Insulin Infusion Systems; 0302 clinical medicine; Humans; Hypoglycemic Agents; Insulin; Multicenter Studies as Topic; Child; Blood Glucose Self-Monitoring/instrumentation; Aged; Randomized Controlled Trials as Topic; Retrospective Studies; Cross-Over Studies; Dose-Response Relationship, Drug; Randomized Controlled Trials as Topic/statistics & numerical data; Blood Glucose Self-Monitoring; Age Factors; Infant; Diabetes Mellitus, Type 1/blood; Middle Aged; Hypoglycemic Agents/administration & dosage; 3. Good health; Diabetes Mellitus, Type 1; Child, Preschool; Female; Insulin/administration & dosage

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.