Closed-loop in children with type 1 diabetes: specific challenges

Abstract

Objective: To review challenges and opportunities related to closed-loop glucose control in children with type 1 diabetes (T1D).

Research design and methods: During closed-loop glucose control, insulin infusion rates on a subcutaneous insulin pump are adjusted by a control algorithm according to subcutaneous glucose sensor readings. A literature review is performed and personal experience of work with closed-loop systems at the University of Cambridge, UK, is presented.

Results: The main challenges in the management of T1D in children are identified together with a summary of current therapeutics options. Review of the literature recognises hypoglycaemia as a limiting factor for the attainment of optimal glycaemic control, primarily in children. Additional specific confounding issues include unpredictable eating and exercise patterns especially in the youngest age group. Closed-loop systems might be particularly helpful, but have to consider increased insulin sensitivity, lower insulin doses, and human factors such as size and usability of closed-loop components.

Conclusions: Closed-loop systems may represent an alternative treatment option to achieve target glucose levels whilst reducing the risk of hypoglycaemia in children with T1D.