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Artificial pancreas helps youngsters with type 1 diabetes

Thursday January 20th 2022

A “life-changing” artificial pancreas is helping young children with type 1 diabetes to manage their blood sugar levels, British researchers reported today.

Researchers at the University of Cambridge say CamAPS FX, their newly developed app, combined with a glucose monitor and insulin pump, acts as an artificial pancreas, automatically adjusting the amount of insulin it delivers based on predicted or real-time glucose levels.

This hybrid closed loop system means the child’s carer only has to administer insulin at mealtimes because the algorithm works by itself at all other times.

The team writes in the latest edition of the *New England Journal of Medicine* that they compared the performance of the artificial pancreas against sensor-augmented pump therapy, which requires parents to review their child’s glucose levels using a monitor and then manually adjust the amount of insulin administered by the pump.

Professor Roman Hovorka from the Wellcome-MRC Institute of Metabolic Science at the University of Cambridge said: “CamAPS FX makes predictions about what it thinks is likely to happen next based on past experience. It learns how much insulin the child needs per day and how this changes at different times of the day.

“It then uses this to adjust insulin levels to help achieve ideal blood sugar levels. Other than at mealtimes, it is fully automated, so parents do not need to continually monitor their child’s blood sugar levels.”

Prof Hovorka and an international team of researchers worked across seven centres in the UK and Europe to recruit 74 children with type 1 diabetes, all aged between one and seven years.

All children used the CamAPS FX hybrid closed-loop system for 16 weeks before swapping to the sensor-augmented pump therapy for 16 weeks.

The team found that on average, children spent about 71.6% of the time in the target range for their glucose levels when using CamAPS FX, which was almost nine percentage points higher compared to the control period. This accounted for an additional 125 minutes per day in the target range.

When using CamAPS FX, the children spent 22.9% of their time with hyperglycaemia, almost nine percentage points lower than during the control period.

However, there was no difference between the two groups in the time spent in hypoglycaemia, say the research team.

The app reduced average glycated haemoglobin (HbA1c). The researchers found that at baseline, average HbA1c levels were 7.3% and the app reduced this by 0.7 percentage points.

First study author Dr Julia Ware, from the Wellcome-MRC Institute of Metabolic Science, said: “Very young children are extremely vulnerable to changes in their blood sugar levels. High levels in particular can have potentially lasting consequences to their brain development. On top of that, diabetes is very challenging to manage in this age group, creating a huge burden for families.

“CamAPS FX led to improvements in several measures, including hyperglycaemia and average blood sugar levels, without increasing the risk of hypos. This is likely to have important benefits for those children who use it.”

The researchers also found that more than 80% of overnight sensor readings were within the target range, which, they say, demonstrates that hybrid closed-loop therapy addresses concerns of variability in insulin requirements and parental fear of hypoglycaemia.

“Parents have described our artificial pancreas as ‘life-changing’ as it meant they were able to relax and spend less time worrying about their child’s blood sugar levels, particularly at nighttime,” said Dr Ware.

CamAPS FX is available through a number of NHS trusts across the UK and the team hope it will soon be available even more widely.

Ware J, Allen JM, Boughton CK et al. et al. Closed-loop in very young children with type 1 diabetes: a randomized trial. *NEJM* 19 January 2022; doi: 10.1056/NEJMoa2111673

Tags: Child Health | Diabetes | UK News

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