Safe and Effective Use of a Hybrid Closed‐loop System from Diagnosis in children under 18 months with type 1 Diabetes

The management of type 1 diabetes in infancy presents significant challenges. Hybrid closed loop systems have been shown to be effective in a research setting and are now available for clinical use. There are relatively little reported data regarding their safety and efficacy in a real world clinical setting. We report two cases of very young children diagnosed with type 1 diabetes at ages 18 (Case 1) and 7 months (Case 2), who were commenced on hybrid closed-loop insulin delivery using the CamAPS FX™ system from diagnosis.

At diagnosis, total daily dose (TDD) was 6 and 3.3 units for Case 1 and 2 respectively. Closed loop was started during the inpatient stay and weekly follow up was provided via video call on discharge.

Seven months from diagnosis, Case 1 has an HbA1C of 49 mmol/mol, 61% time in range (TIR, 3.9-10 mmol/L) with 2% time in hypoglycaemia (<3.9 mmol/L) with no incidents of very low blood glucose (BG) (<3 mmol/L, 54 mg/dL) over 6 months.

Given the extremely small total daily dose of insulin in Case 2,we elected to use diluted insulin (insulin aspart injection, NovoLog, Novo Nordisk Inc., Plainsboro, NJ, USA, Diluting Medium for NovoLog®). Six months from diagnosis, the estimated HbA1c is 50 mmol/mol, TIR 76% with 1% hypoglycaemia and no incidents of very low blood glucose (BG) (<3 mmol/L, 54 mg/dL) over 6 months.

We conclude that the use hybrid closed-loop can be safe and effective from diagnosis in children under 2 years of age with type 1 diabetes.

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