28KIT
THE YOUNG ONES
Should youth with Type 1 diabetes use closed-loop systems?
International and French
recommendations on closedloop systems state
that the use
of an 'artificial pancreas' should
be reserved for adults who are
fully engaged with their treatment.
This means that young patients,
especially adolescents, who are less
likely to comply with treatment and
are more likely to experience suboptimal blood glucose
control, are
often excluded from the use of such
systems for managing their diabetes.
However, several recent studies seem
to call this approach into question.
One such study, which was
presented at a Francophone
Diabetes Society conference and was
published in Nature Communications,
showed that adolescents with
poorly controlled diabetes who were
equipped with closed-loop systems
gained in their capacity to reason.
Furthermore, with the closed-loop
system, they spent 13% more time
2023 also showed a favourable
risk-benefit ratio for closed-loop
systems. The trial, which enrolled
102 children aged two-to-six who
had Type 1 diabetes, showed that
the amount of time that the glucose
level was within the target range
during the 13-week study period was
higher (+3 hours) for those who had
been randomly assigned to receive
the hybrid closed-loop system (68 of
the children) than for those who had
received the standard treatment (34
of the children), either with an insulin
pump or multiple daily injections and
a Dexcom G6 continuous glucose
monitoring device.
A previous study carried out by
the Paris Public Hospital System
had already shown that the French
Diabeloop (DBLG1) system could
These are the very
same youngsters
who didn't want
to hear about
their diabetes in
the past. They
are delighted
to be once
again involved
in managing
their condition ~
Prof Renard
in a target range, and there was a
significant reduction in time spent in
hyperglycaemia.
In the same vein, a small
prospective study published in
Diabetes Care in January 2023
showed that the closed-loop system
using the Minimed 780G pump
improved glycaemic control for 20
young people with Type 1 diabetes
aged 13 to 25 years whose diabetes
was poorly controlled (defined as
being an HbA1c of more than 8.5%).
At the end of the three-month
study period, the average HbA1c had
decreased from 10.5% to 7.6%, an
average decrease of 2.9%. The time
spent in target HbA1c was increased
by almost 40%.
Very young
With respect to very young children,
a study published in The New
England Journal of Medicine in March