Young Children Have Higher Variability of Insulin Requirements: Observations During Hybrid Closed-Loop Insulin Delivery
Authors: Dovc Klemen , Boughton Charlotte , Tauschmann Martin , Thabit Hood , Bally Lia , Allen Janet M. , Acerini Carlo L. , Arnolds Sabine , de Beaufort Carine , Bergenstal Richard M. , Campbell Fiona , Criego Amy , Dunger David B. , Elleri Daniella , Evans Mark L. , Fröhlich-Reiterer Elke , Hofer Sabine , Kapellen Thomas , Leelarathna Lalantha , Pieber Thomas R. , Rami-Merhar Birgit , Shah Viral N. , Sibayan Judy , Wilinska Malgorzata E. , Hovorka Roman ,   APCam11, AP@Home, and KidsAP Consortia, Dovc Klemen , Tauschmann Martin , Boughton Charlotte , Musolino Gianluca , Thabit Hood , Bally Lia , Slegtenhorst Sonja , Allen Janet M. , Wilinska Malgorzata E. , Ruan Yue , Hayes Josephine , Barber Nicole , Curtis Jane , Acerini Carlo L. , Dunger David B. , Evans Mark L. , Hovorka Roman , Leelarathna Lalantha , Thabit Hood , Shaju Angel , Yau Stefanie , James Linda , Balakrishnan Karthirani , Donahue Denise , Mubita Womba , Exall Jane , Yong James , Forshaw Rachel , Pad Rebecca , Heath Stephanie , Metcalfe Emily , Campbell Fiona , Sibayan Judy , Kollman Craig , Cheng Peiyao , Beck Roy W. , Lum John , Borgman Sarah , Huegel Viki , Bradshaw Sydnee , Hellman Amanda , Patibandla Nanadan , McCarthy Chris , Murphy Carlos , Bugielski Brian , Alvarado Barvan , Elleri Daniella , McDonald Morag , Bath Louise , Miles Harriet , Miller Debbie , Collett Emily , Baggott Julie , Riding Key , Thomson Jane , Bergenstal Richard M. , Criego Amy , Carlson Anders B. , Martens Thomas , Beasley Shannon , Madden M. , Olson Beth , Hyatt Jamie , Ashanti Charlotte , Mikityuk Vera , Thomas LeeAnn , Konerza Wanda , Shah Viral N. , Joseph Hal , Beatson Christie R. , Demmitt Jamie K. , Joshee Prakriti , White Dawn , Kojzar Harald , Mader Julia K. , Suppan Elisabeth , Pieber Thomas R. , Fröhlich-Reiterer Erike E. , Ellmerer Martin , Holzer Manuel , Schaeffer Dominique , Fichelle Muriel , Schierloh Ulrike , de Beaufort Carine , Thiele Alena G. , Bartelt Heike , Kapellen Thomas M. , Abt Daniela , Meraner Dagmar , Binder Elisabeth , Steichen Elisabeth , Hackl Lukas , Hofer Sabine , Rami Merhar Birgit , Fritsch Maria , Nagl Katrin , Katzenbeisser-Pawlik Sonja , Tauschmann Martin , Arnolds Sabine , Benesch Carsten , Dellweg Sibylle , Haase Martina , Heinemann Lutz , Kuschma Kirstin , Luebkert Maren , Przetak Elke , Schmitz-Grozs Krisztina 
Published: June 2019

OBJECTIVE
To quantify age-related variability of insulin needs during day and night closed-loop insulin delivery.

RESEARCH DESIGN AND METHODS
We retrospectively analyzed data from hybrid closed-loop studies involving young children (1–6 years old, n = 20), children (7–12 years, n = 21), adolescents (13–17 years, n = 15), and adults (&gt;18 years, n = 58) with type 1 diabetes. The coefficient of variation quantified variability of insulin needs during 3 weeks of unrestricted-living hybrid closed-loop use.

RESULTS
Data from 2,365 nights and 2,367 days in 114 participants were analyzed. The coefficient of variation of insulin delivery was higher in young children compared with adults (mean difference at nighttime 10.7 percentage points [95% CI 2.9–18.4], P = 0.003; daytime 6.4 percentage points [95% CI 2.0–10.9], P = 0.002) and compared with adolescents (mean difference at nighttime 10.2 percentage points [95% CI 0.0–20.4], P = 0.049; daytime 7.0 percentage points [95% CI 1.1–12.8], P = 0.014).

CONCLUSIONS
Diabetes management in young children is complicated by higher variability in insulin requirements, supporting fast-track clinical practice adoption of closed-loop in this vulnerable population.