Benefits and Challenges of Current Closed-Loop Technologies in Children and Young People With Type 1 Diabetes

Abstract

Recent advances in diabetes technology have led to the development of closed-loop insulin delivery systems for the management of type 1 diabetes. Several such systems are now commercially available for children and young people. While all available systems have been shown to improve glycaemic control and quality of life in this population, qualitative data also highlights the challenges in using closed-loop systems, which vary among different pediatric age-groups. Very young children require systems that are able to cope with low insulin doses and significant glycaemic variability due to their high insulin sensitivity and unpredictable eating and exercise patterns. Adolescents' compliance is often related to size and number of devices, usability of the systems, need for calibrations, and their ability to interact with the system. Given the speed of innovations, understanding the capabilities and key similarities and differences of current systems can be challenging for healthcare professionals, caregivers and young people with type 1 diabetes alike. The aim of this review is to summarize the key evidence on currently available closed-loop systems for children and young people with type 1 diabetes, as well as commenting on user experience, where real-world data are available. We present findings on a system-basis, as well as identifying specific challenges in different pediatric age-groups and commenting on how current systems might address these. Finally, we identify areas for future research with regards to closed-loop technology tailored for pediatric use and how these might inform reimbursement and alleviate disease burden.

Emerging strategies for beta cell transplantation to treat diabetes

“…Tight glucose control decreases T1D complications [2,3] at the expense of increased hypoglycemic episodes [4]. Various technologies streamline T1D treatment and reduce patient burden, including continuous glucose sensors [5,6], smart infusion pumps [7], and the artificial pancreas [8]; however, the inability to fully recapitulate the complex biological feedback loop of beta cells remains a major challenge in restoring the health of individuals living with T1D [9].…”

Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

“…In the framework of personalized precision medicine, closed-loop control has the potential for success in individuals with unique physiological, pathological, and behavioral characteristics that influence glycemic control, such as pregnant women, very young children, critical care patients, dialysis patients, shift workers, and travelers. Most commercially available hybrid closed-loop systems are licensed for use in children, albeit with varying minimum ages for use ( 69 ). CamAPS FX is the only system currently licensed for use in pregnancy, although there are case reports of off-label use of the MiniMed 670G by pregnant women ( 70 , 71 ).…”

Recent advancements in noninvasive glucose monitoring and closed-loop management systems for diabetes

“…The controller analyzes the data and sends the instructions to the insulin pump through a specific algorithm. 151,152…”