'Artificial Pancreas' Can Help Kids With Type 1 Diabetes
Having a child with type 1 diabetes can be a challenging health condition for parents to manage, but new research suggests an "artificial pancreas" system may beat standard treatment in controlling the blood sugar disease in young children.
Forms of the technology -- which automatically monitors and regulates blood sugar -- are already available for adults and kids with type 1 diabetes. The systems have been shown to improve blood sugar control and make life easier for people with the disease.
Until recently, most research on artificial pancreas systems has focused on adults or older children, though one system is approved in the United States for children aged 2 to 6.
The new study, published Jan. 20 in the New England Journal of Medicine, adds to evidence that the technology is safe for toddlers and preschoolers -- and may better control their disease.
Type 1 diabetes is far less common than type 2 diabetes, which typically strikes in adulthood and is often associated with obesity.
The type 1 form is caused by a misguided immune system attack on the body's insulin-producing cells. Insulin is a hormone that regulates blood sugar, and people with type 1 diabetes need to take synthetic insulin daily.
Traditionally, that meant taking multiple "finger sticks" each day to measure blood sugar levels, then injecting the right amount of insulin.
Some advances have made the task easier: Instead of injections, people can opt for a "pump" that delivers insulin doses throughout the day via a small tube just under the skin. And an alternative to finger sticks is the continuous glucose monitor -- a device that tracks blood sugar 24 hours a day, via a sensor placed under the skin.
Even with those technologies, though, managing type 1 diabetes remains daunting -- especially in young children, experts said.
Parents still have to calculate how much insulin the pump should deliver and make frequent changes, both day and night, said lead researcher Dr. Julia Ware.
The artificial pancreas -- also called a hybrid closed-loop system -- connects the insulin pump and glucose monitor into a single automated system. The middle man is a computer algorithm that analyzes the monitor's glucose readings and automatically adjusts the pump's insulin doses.
"This automation significantly reduces the burden for parents, particularly at nighttime," said Ware, of the Wellcome Trust-MRC Institute of Metabolic Science at the University of Cambridge, in England.
That point was echoed by Sanjoy Dutta, vice president of research for the nonprofit JDRF (formerly called the Juvenile Diabetes Research Foundation), which helped fund the study.
"Now parents can sleep through the night," Dutta said.
Beyond that, better blood sugar control from an early age is critical, he added. Over the years, chronically high blood sugar can damage blood vessels and nerves throughout the body. Better control can lower the risks of long-term complications like heart, kidney and eye disease, Dutta said.
Blood sugar extremes -- very high or very low -- can also cause immediate problems with thinking, attention and other mental abilities. And young children are particularly vulnerable to that, said Dr. Meredith Wilkes, medical director of the Pediatric Diabetes Center at Mount Sinai, in New York City.
Wilkes, who was not involved in the trial, agreed that managing diabetes in young kids is especially challenging: They often cannot sense symptoms of blood sugar extremes, and rely on their parents and other caregivers for monitoring.
"The hope is that newer technology, especially artificial pancreas systems, will not only improve [diabetes] control, but also make management easier for caregivers," Wilkes said.
The new trial included 74 children aged 2 to 7. Each spent 16 weeks using a traditional glucose monitor and insulin pump, and 16 weeks using an artificial pancreas system developed by the Cambridge researchers.
On average, the study found, the children spent about 72% of the day within normal blood sugar range when they were using the artificial pancreas -- just over two hours more than standard treatment.
The system also reduced instances of very high blood sugar, without increasing potentially dangerous blood sugar lows.
"Right now, hybrid closed-loop systems are the best treatment we have," Dutta said.
In the United States, Medtronic's MiniMed 770G is approved for children as young as 2. And other systems are being studied in very young children, Dutta noted.
The technology does not come cheap, and there is an ongoing cost of supplies for the glucose monitor and pump. Even with insurance coverage, Dutta noted, cost can be an obstacle for some families.
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on artificial pancreas systems.
SOURCES: Julia Ware, MD, clinical research associate, Institute of Metabolic Science, University of Cambridge, U.K.; Sanjoy Dutta, PhD, vice president, research, JDRF, New York City; Meredith Wilkes, MD, medical director, Pediatric Diabetes Center, Icahn School of Medicine at Mount Sinai, New York City; New England Journal of Medicine, Jan. 20, 2022