Issue: March 2021
Disclosures: Wadwa reports he has received consultant fees from Tandem Diabetes Care and that the study was supported by a research grant from Tandem Diabetes Care. Please see the study for all other authors’ relevant financial disclosures.
February 02, 2021
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Artificial pancreas may be safe for young children with type 1 diabetes

Issue: March 2021
Disclosures: Wadwa reports he has received consultant fees from Tandem Diabetes Care and that the study was supported by a research grant from Tandem Diabetes Care. Please see the study for all other authors’ relevant financial disclosures.
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A modified version of an FDA-approved close-loop insulin delivery system may be effective for children aged 2 to 5 years with type 1 diabetes, according to study data published in Diabetes Technology & Therapeutics.

In June, the FDA approved the use of the Tandem Diabetes Care t:slim X2 insulin pump with Control-IQ technology for children aged 6 years and older. The study assessed the device and algorithm used with the Dexcom G6 continuous glucose monitor as an artificial pancreas system.

A group of children aged 2 to 5 years spent more time in range and less time in hyperglycemia with a modified version of the Tandem Diabetes Care t:slim X2 insulin pump with Control-IQ technology.

“A modified version of Control-IQ technology appears to be safe in young children aged 2 to 5 years with type 1 diabetes,” R. Paul Wadwa, MD, professor of pediatrics at the Barbara Davis Center for Diabetes at the University of Colorado Anschutz Medical Campus, told Healio. “But larger and longer studies are needed to provide more data on safety and efficacy of Control-IQ technology in young children under 6 years of age with type 1 diabetes.”

R. Paul Wadwa

Wadwa and colleagues conducted a brief pilot study on the X2 insulin pump with Control-IQ technology in children aged 2 to 5 years who had type 1 diabetes for at least 3 months, were users of an insulin pump and a Dexcom continuous glucose monitor, and had a daily insulin dose of at least 5 U. Parents or guardians of the participants were trained on the Tandem t:slim X2 insulin pump with Control-IQ and the Dexcom G6 CGM at the start of the study. A study glucose meter and blood ketone meter were also provided.

Participants began the study with a 48-hour stay at a supervised hotel staffed with a physician and medical personnel. The parent or guardian was responsible for using the system during the stay. There were no dietary restrictions, and planned group activities, including daily exercise, took place. After the 48-hour period concluded, participants used the Control-IQ system at home for 72 hours under parental supervision and remote study staff monitoring. Parents completed a technology acceptance questionnaire at the end of the study. Researchers also analyzed CGM trends during the study and checked blood ketone levels at the beginning and end of the supervised hotel period.

The study included 12 participants, with four each at Stanford University, University of Virginia and the Barbara Davis Center for Diabetes. At baseline, 33% of participants achieved the primary outcome of less than 6% of time in hypoglycemic range of less than 70 mg/dL and less than 40% of their time in the hyperglycemic range of greater than 180 mg/dL. After using Control-IQ, 83% of participants achieved the primary outcome. The study population also had improvements in time in range on Control-IQ vs. baseline (71.3% vs. 61.7%, P = .016) and a significant reduction in time in hyperglycemia (34.1% vs. 25.7%, P = .042). The percent time in hypoglycemia was similar on Control-IQ compared with baseline.

During the supervised hotel stay, participants remained in closed loop 98.4% of the time. The number remained high during the at-home portion of the study, with closed loop used 97.5% of the time. Results from the questionnaire showed parents had a favorable response to the Control-IQ system, giving it high scores for ease of use and usefulness, while also reporting a minimal burden with its use. There were no severe hypoglycemia events or diabetic ketoacidosis episodes during the study.

After the brief study showed favorable findings, researchers are now planning for a larger study to see whether the findings are replicated.

“We need a larger outpatient study of Control-IQ technology in young children under 6 years of age with type 1 diabetes carried out over a longer period of time,” Wadwa said. “Such a study has received U01 funding from the National Institute of Diabetes and Digestive and Kidney Diseases, and we hope that this study will begin in early 2021.”

For more information:

R. Paul Wadwa, MD, can be reached at paulwadwa@cuanschutz.edu.