medwireNews: Use of an artificial pancreas system results in improved glycaemic control relative to insulin pump use among pre-adolescent children attending a diabetes camp, research shows.
“This is the first time, to our knowledge, that an automated glucose control system has been shown to be effective in young children, who are often unable to take care of themselves without the assistance of adult caregivers and are therefore likely to particularly benefit from automated glycaemic control”, say Edward Damiano (Boston University, Massachusetts, USA) and study co-authors.
Previous studies of artificial pancreas systems have mostly focused on adults and teenagers, although one study of at-home overnight use included younger children.
In a commentary accompanying the current study, in The Lancet Diabetes & Endocrinology, Bruce Buckingham and Trang Ly, from Stanford University in Palo Alto, California, USA, note that, in general, insulin sensitivity changes from prepubescence to adolescence and therefore algorithm testing in prepubescent children “is important to gauge safety and efficacy of a one-size-fits-all system.”
During days 2–5 of 5 days of using the artificial pancreas, the 19 study participants, aged from 6 to 11 years (average 9.3 years), had an average 24-hour blood glucose level of 7.6 mmol/L, measured with a continuous glucose monitoring system. This was significantly less than the average 9.3 mmol/L recorded during days 2–5 of using standard insulin pump therapy.
There was a 3-day washout period between the artificial pancreas and insulin pump test periods, which occurred in a randomly assigned order. The camp doctor was responsible for determining the daily insulin needs during the pump therapy phase in the children, all of whom had Type 1 diabetes.
The artificial pancreas was a bihormonal system, delivering insulin and glucagon. Buckingham and Ly note that the system is currently “unique in that it does not require carbohydrates to be counted”.
Instead, during the artificial pancreas phase, camp staff simply entered the type of meal (ie, breakfast, lunch, dinner) and whether it was of typical size or smaller/larger than normal 5–15 minutes before the children ate.
As well as delivering lower blood glucose, the artificial pancreas also reduced the amount of time children spent with a blood glucose level below 3.3 mmol/L, at 1.2% versus 2.8% with insulin pump therapy. There was a corresponding reduction in the number of carbohydrate interventions given for glucose lower than 3.9 mmol/L, at three versus five, and medium-to-large ketone levels occurred seven times in five children during the insulin pump phase but not during the artificial pancreas phase.
“The bionic pancreas thus provided better glycaemic regulation with less effort devoted to diabetes decision making and management than is possible with the current standard of care in diabetes management”, say Damiano and team.
By Eleanor McDermid, Senior medwireNews Reporter
Lancet Diabetes Endocrinol 2016; Advance online publication
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