March 28, 2023

Artificial pancreas controls blood sugar in young children with type 1 diabetes

At a Glance

  • Children aged 2 to 5 with type 1 diabetes who received an artificial pancreas had more stable blood glucose levels than those who received standard care.
  • The improvement translated into about three hours a day of better blood glucose control, with the largest benefit seen at nighttime.
Small child and doctor talking in clinic Type 1 diabetes can be especially difficult to manage in younger children, but an artificial pancreas system may help. Pressmaster / Shutterstock

In type 1 diabetes, the immune system attacks and destroys the cells in the pancreas that produce insulin. This hormone normally helps the body’s cells take up glucose, a type of sugar, from the bloodstream. Without insulin, levels of blood glucose can swing dangerously high, leading to both short- and long-term health problems.

The standard treatment for type 1 diabetes has been to use frequent blood glucose testing to guide insulin injections. Recently, researchers have developed artificial pancreas systems. These systems contain a continuous blood glucose monitor and an insulin pump. The monitor constantly provides feedback to the pump, which supplies insulin automatically when needed.

Previous studies have shown that such systems improve blood glucose control in adults and in older children. But type 1 diabetes can be especially difficult to manage in younger children, who often can’t express when they feel the effects of low or high blood sugar.

In a new study, an NIH-funded team led by Dr. Marc Breton from the University of Virginia tested an artificial pancreas in children aged 2 to 5 with type 1 diabetes. Because the study took place during the COVID-19 pandemic, most of the trial visits were conducted virtually. Results from the randomized clinical trial were published on March 16, 2023, in the New England Journal of Medicine.

A glucose monitor with a small unit showing insulin levels. The Control-IQ artificial pancreas system used in the study. Tandem Diabetes Care

The researchers recruited 102 children who had been diagnosed with type 1 diabetes at least six months before joining the study. The team randomly assigned 68 children to receive a closed-loop artificial pancreas system and 34 to continue receiving standard care. The children in the latter group also received a continuous glucose motor.

At the start of the trial, the children had blood glucose levels that fell within a target rage about 55% of the time. At thirteen weeks after implantation, blood glucose levels for children who received the artificial pancreas fell into that range almost 70% of the time. For those who remained on standard care, levels were about the same as at the start of the trial.

This difference translated to children with the artificial pancreas having blood glucose levels in the target range for an additional three hours per day. The difference between groups was most pronounced at nighttime, when the children would normally be sleeping. Children with the highest blood sugar levels at the start of the trial benefitted the most from the artificial pancreas.

“Artificial pancreas systems have the potential to improve all-day blood glucose control in these young patients. This could help ease fears families may have about low blood glucose, in particular during the night, as well as concerns about the long-term effects of type 1 diabetes on their children’s health,” says Dr. Guillermo Arreaza-Rubin of NIH’s National Institute of Diabetes and Digestive and Kidney Diseases.

Because telemedicine was successfully used to teach families how to use the device, the study suggests this technology could be made available to people in areas without nearby specialty care.

Additional studies are needed to see if the benefits of the artificial pancreas observed over the 13 weeks of the trial are sustained in the long term.

—by Sharon Reynolds

Related Links

References: Trial of Hybrid Closed-Loop Control in Young Children with Type 1 Diabetes. Wadwa RP, Reed ZW, Buckingham BA, DeBoer MD, Ekhlaspour L, Forlenza GP, Schoelwer M, Lum J, Kollman C, Beck RW, Breton MD; PEDAP Trial Study Group. N Engl J Med. 2023 Mar 16;388(11):991-1001. doi: 10.1056/NEJMoa2210834. PMID: 36920756.

Funding: NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).