Young Children Have Higher Variability of Insulin Requirements: Observations During Hybrid Closed-Loop Insulin Delivery

被引：62

作者：

Dovc, Klemen ^{[1
,2
]}

Boughton, Charlotte ^{[1
]}

Tauschmann, Martin ^{[1
,3
]}

Thabit, Hood ^{[1
,4
]}

Bally, Lia ^{[1
,5
,6
,7
,8
]}

Allen, Janet M. ^{[1
,9
]}

Acerini, Carlo L. ^{[1
,9
]}

Arnolds, Sabine ^{[10
]}

de Beaufort, Carine ^{[11
]}

Bergenstal, Richard M. ^{[12
]}

Campbell, Fiona ^{[13
]}

Criego, Amy ^{[12
]}

Dunger, David B. ^{[1
,9
]}

Elleri, Daniella ^{[14
]}

Evans, Mark L. ^{[1
,15
]}

Froehlich-Reiterer, Elke ^{[16
]}

Hofer, Sabine ^{[17
]}

Kapellen, Thomas ^{[18
]}

Leelarathna, Lalantha ^{[4
]}

Pieber, Thomas R. ^{[19
]}

Rami-Merhar, Birgit ^{[3
]}

Shah, Viral N. ^{[20
]}

Sibayan, Judy ^{[21
]}

Wilinska, Malgorzata E. ^{[1
,9
]}

Hovorka, Roman ^{[1
,9
]}

机构：

[1] Univ Cambridge, Wellcome Trust MRC Inst Metab Sci, Cambridge, England

[2] Univ Childrens Hosp, Univ Med Ctr, Dept Pediat Endocrinol Diabet & Metab Dis, Ljubljana, Slovenia

[3] Med Univ Vienna, Dept Pediat & Adolescent Med, Vienna, Austria

[4] Manchester Univ Hosp Natl Hlth Serv NHS Fdn Trust, Manchester Diabet Ctr, Manchester, Lancs, England

[5] Univ Bern, Dept Diabet, Inselspital, Univ Hosp Bern, Bern, Switzerland

[6] Univ Bern, Dept Endocrinol, Inselspital, Univ Hosp Bern, Bern, Switzerland

[7] Univ Bern, Dept Clin Nutr, Inselspital, Univ Hosp Bern, Bern, Switzerland

[8] Univ Bern, Dept Metab, Inselspital, Univ Hosp Bern, Bern, Switzerland

[9] Univ Cambridge, Dept Paediat, Cambridge, England

[10] Profil Inst Stoffwechselforsch GmbH, Neuss, Germany

[11] CH Luxembourg, DECCP, Clin Pediat, Luxembourg, Luxembourg

[12] Int Diabet Ctr Pk Nicollet, St Louis Pk, MN USA

[13] Leeds Childrens Hosp, Dept Paediat Diabet, Leeds, W Yorkshire, England

[14] Royal Hosp Sick Children, Edinburgh, Midlothian, Scotland

[15] Cambridge Univ Hosp NHS Fdn Trust, Dept Diabet & Endocrinol, Cambridge, England

[16] Med Univ Graz, Dept Pediat & Adolescent Med, Graz, Austria

[17] Med Univ Innsbruck, Dept Pediat 1, Innsbruck, Austria

[18] Univ Leipzig, Div Paediat Diabetol, Leipzig, Germany

[19] Med Univ Graz, Div Endocrinol & Diabetol, Dept Internal Med, Graz, Austria

[20] Univ Colorado, Barbara Davis Ctr Diabet, Denver, CO 80202 USA

[21] Jaeb Ctr Hlth Res, Tampa, FL USA

来源：

DIABETES CARE | 2019年 / 42卷 / 07期

基金：

欧盟地平线“2020”; 英国惠康基金;

关键词：

TYPE-1; ADOLESCENTS; AGE;

D O I：

10.2337/dc18-2625

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 (>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.

引用

页码：1344 / 1347

页数：4

共 12 条

[1] Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis [J].

Bekiari, Eleni ;

Kitsios, Konstantinos ;

Thabit, Hood ;

Tauschmann, Martin ;

Athanasiadou, Eleni ;

Karagiannis, Thomas ;

Haidich, Anna-Bettina ;

Hovorka, Roman ;

Tsapas, Apostolos .

BMJ-BRITISH MEDICAL JOURNAL, 2018, 361

[2] Clinical Presentation and Autoimmune Characteristics of Very Young Children at the Onset of Type 1 Diabetes Mellitus [J].

Carla, Bizzarri ;

Danila, Benevento ;

Paolo, Ciampalini ;

Patrizia, Patera Ippolita ;

Riccardo, Schiaffini ;

Antonella, Migliaccio ;

Lucilla, Rava ;

Marco, Cappa .

JOURNAL OF PEDIATRIC ENDOCRINOLOGY & METABOLISM, 2010, 23 (11) :1151-1157

[3] Fall in C-Peptide During First 4 Years From Diagnosis of Type 1 Diabetes: Variable Relation to Age, HbA1c, and Insulin Dose [J].

Hao, Wei ;

Gitelman, Steven ;

DiMeglio, Linda A. ;

Boulware, David ;

Greenbaum, Carla J. .

DIABETES CARE, 2016, 39 (10) :1664-1670

[4] Variability of Insulin Requirements Over 12 Weeks of Closed-Loop Insulin Delivery in Adults With Type 1 Diabetes [J].

Ruan, Yue ;

Thabit, Hood ;

Leelarathna, Lalantha ;

Hartnell, Sara ;

Willinska, Malgorzata E. ;

Dellweg, Sibylle ;

Benesch, Carsten ;

Mader, Julia K. ;

Holzer, Manuel ;

Kojzar, Harald ;

Evans, Mark L. ;

Pieber, Thomas R. ;

Arnolds, Sabine ;

Hovorka, Roman .

DIABETES CARE, 2016, 39 (05) :830-832

[5] Use of insulin pump therapy in children and adolescents with type 1 diabetes and its impact on metabolic control: comparison of results from three large, transatlantic paediatric registries [J].

Sherr, Jennifer L. ;

Hermann, Julia M. ;

Campbell, Fiona ;

Foster, Nicole C. ;

Hofer, Sabine E. ;

Allgrove, Jeremy ;

Maahs, David M. ;

Kapellen, Thomas M. ;

Holman, Naomi ;

Tamborlane, William V. ;

Holl, Reinhard W. ;

Beck, Roy W. ;

Warner, Justin T. .

DIABETOLOGIA, 2016, 59 (01) :87-91

[6] Home Use of Day-and-Night Hybrid Closed-Loop Insulin Delivery in Very Young Children: A Multicenter, 3-Week, Randomized Trial [J].

Tauschmann, Martin ;

Allen, Janet M. ;

Nagl, Katrin ;

Fritsch, Maria ;

Yong, James ;

Metcalfe, Emily ;

Schaeffer, Dominique ;

Fichelle, Muriel ;

Schierloh, Ulrike ;

Thiele, Alena G. ;

Abt, Daniela ;

Kojzar, Harald ;

Mader, Julia K. ;

Slegtenhorst, Sonja ;

Barber, Nicole ;

Wilinska, Malgorzata E. ;

Boughton, Charlotte ;

Musolino, Gianluca ;

Sibayan, Judy ;

Cohen, Nathan ;

Kollman, Craig ;

Hofer, Sabine E. ;

Froehlich-Reiterer, Elke ;

Kapellen, Thomas M. ;

Acerini, Carlo L. ;

de Beaufort, Carine ;

Campbell, Fiona ;

Rami-Merhar, Birgit ;

Hovorka, Roman .

DIABETES CARE, 2019, 42 (04) :594-600

[7] Closed-loop insulin delivery in suboptimally controlled type 1 diabetes: a multicentre, 12-week randomised trial [J].

Tauschmann, Martin ;

Thabit, Hood ;

Bally, Lia ;

Allen, Janet M. ;

Hartnell, Sara ;

Wilinska, Malgorzata E. ;

Ruan, Yue ;

Sibayan, Judy ;

Kolman, Craig ;

Cheng, Peiyao ;

Beck, Roy W. ;

Acerini, Carlo L. ;

Evans, Mark L. ;

Dunger, David B. ;

Elleri, Daniela ;

Campbell, Fiona ;

Bergenstal, Richard M. ;

Criego, Amy ;

Shah, Viral N. ;

Leelarathna, Lalantha ;

Hovorka, Roman .

LANCET, 2018, 392 (10155) :1321-1329

[8] Home Use of Day-and-Night Hybrid Closed-Loop Insulin Delivery in Suboptimally Controlled Adolescents With Type 1 Diabetes: A 3-Week, Free-Living, Randomized Crossover Trial [J].

Tauschmann, Martin ;

Allen, Janet M. ;

Wilinska, Malgorzata E. ;

Thabit, Hood ;

Acerini, Carlo L. ;

Danger, David B. ;

Hovorka, Roman .

DIABETES CARE, 2016, 39 (11) :2019-2025

[9] Home Use of an Artificial Beta Cell in Type 1 Diabetes [J].

Thabit, H. ;

Tauschmann, M. ;

Allen, J. M. ;

Leelarathna, L. ;

Hartnell, S. ;

Wilinska, M. E. ;

Acerini, C. L. ;

Dellweg, S. ;

Benesch, C. ;

Heinemann, L. ;

Mader, J. K. ;

Holzer, M. ;

Kojzar, H. ;

Exall, J. ;

Yong, J. ;

Pichierri, J. ;

Barnard, K. D. ;

Kollman, C. ;

Cheng, P. ;

Hindmarsh, P. C. ;

Campbell, F. M. ;

Arnolds, S. ;

Pieber, T. R. ;

Evans, M. L. ;

Dunger, D. B. ;

Hovorka, R. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 373 (22) :2129-2140

[10] Nighttime is the worst time: Parental fear of hypoglycemia in young children with type 1 diabetes [J].

Van Name, Michelle A. ;

Hilliard, Marisa E. ;

Boyle, Claire T. ;

Miller, Kellee M. ;

DeSalvo, Daniel J. ;

Anderson, Barbara J. ;

Laffel, Lori M. ;

Woerner, Stephanie E. ;

DiMeglio, Linda A. ;

Tamborlane, William V. .

PEDIATRIC DIABETES, 2018, 19 (01) :114-120

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