Glucose levels in children ages 2 to 5 with Type 1 diabetes were within the target range for a longer period of time with an artificial pancreas than with standard care, according to a study published in The New England Journal of Medicine.

The NIH-supported study compared the effects of artificial pancreas technology versus standard care by assessing glucose levels among 102 children in a 13-week randomized controlled trial. 

An artificial pancreas, also known as a closed-loop control system, is a diabetes management system that uses a continuous glucose monitor to track blood glucose levels and automatically deliver insulin as necessary through an insulin pump.   

Standard care consisted of participants using either an insulin pump or multiple daily insulin injections and a continuous glucose monitor.

Conducted at three pediatric diabetes centers across the U.S., the trial included two study groups, with 68 participants in the artificial pancreas technology group and 34 in the standard care group.  

Due to pandemic restrictions, initiation of the closed-loop system was virtual in 55 patients, or 81%, and 90% of the visits within the study were performed virtually due to COVID-19.

Researchers concluded that participants in the artificial pancreas group spent 12% more time, or approximately three hours per day, within range of their target blood glucose level of 70 to 180 mg per deciliter, as measured by continuous glucose monitoring, compared to the standard care group.

The most significant difference between the groups was seen at nighttime, between 10 p.m. and 6 a.m., with participants in the artificial pancreas group spending 18% more time within their target range. 

The percentage of time glucose levels were above 250 mg per deciliter was also better among the group using the closed-loop system. Still, no significant difference existed between the groups in the portion of time glucose levels fell below 70 mg per deciliter. 

Similar numbers of severe hypoglycemia were seen among both groups. One instance of diabetic ketoacidosis occurred in the artificial pancreas group, though researchers noted it was due to a problem with the insulin pump tubing.

The researchers noted diabetes management in children younger than age 6 is challenging, due to their varying degrees of activity, their need for small doses of insulin and their unpredictable food intake. They also have difficulty relaying their need for hypoglycemia treatment and experience fluctuations in blood glucose levels more commonly than older children. 

"In this trial involving young children with type 1 diabetes, the glucose level was in the target range for a greater percentage of time with a closed-loop system than with standard care," the study's authors wrote.

Benjamin Knisely and Holly Pavliscsak will offer more detail during their HIMSS23 session "Natural Language Processing to Identify Unmet Needs in Military Medicine." It is scheduled for Tuesday, April 18, at 11:45 a.m. - 12:15 p.m. CT at the South Building, Level 1, in room S104.