In This Issue of Diabetes Care

Abstract

The ambition of creating a viable closed-loop insulin therapy system for the treatment of type 1 diabetes, otherwise known as the artifi cial pancreas (AP), has taken a step forward. Tauschmann et al. (p. 594) reveal the successful use of a version of the approach in free-living very young (1–7 years) children, with a convincing clinical outcome. The authors report that their approach appears to be feasible in young children and also appears to be safe from the perspective of avoiding hypoglycemia. Additionally, they also report that there is no tangible difference in using standard concentrations of insulin versus a diluted version in this population. They report an open-label, multicenter, crossover study that initially involved 24 very young individuals with type 1 diabetes who, along with their parents, agreed to use a tech combination that formed an operational AP. The study involved two 21-day periods of use, separated by a washout period with one period involving standard (U100) concentrations of insulin and the other a diluted version (U20). There were no real differences between the periods in terms of mean glucose levels and variability, the proportion of time spent within ranges, and the amount of insulin delivered in the periods. On the safety front, again there were no differences between the periods that could be tied to either the AP system or the different insulin doses. Commenting more widely on the study, author Roman Hovorka told Diabetes Care: “Managing diabetes in very young children places a huge burden on families due to highly fl uctuating insulin needs during and between days. We showed that closed-loop insulin delivery is feasible, safe, and achieves excellent glucose control— especially overnight—helping families to live better lives. Diluting insulin for children with a total daily dose above 10 units per day does not change the outcomes. We are planning a longer and larger study based on these exciting observations.” Higher Doses of Insulin in Long-term Therapy Associated With Cardiometabolic Risks in Type 1 Diabetes