Children with type 1 diabetes who attended a virtual education “camp” to learn how to make the most of their closed-loop insulin delivery system spent more time in their target glucose range, according to a new study published in the journal JAMA Network Open.
A closed-loop insulin delivery system — also known as an automated insulin delivery system, or an artificial pancreas — consists of a continuous glucose monitoring (CGM) system that communicates with an insulin pump to automatically regulate blood glucose levels with minimal input from the user. These systems have improved substantially in recent years, and a number of studies have shown that they are safe and effective — including in older people with type 1 diabetes and in young children with type 1 diabetes. Research suggests that compared with using a CGM system and an insulin pump separately — known as sensor-augmented therapy — using a closed-loop system may lead to improved blood glucose control, as well as potentially an improved quality of life.
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For the latest study, researchers looked at the effects of a “virtual education camp” designed for children and adolescents with type 1 diabetes in Italy who began using an upgraded closed-loop system in 2020. A total of 43 participants from 19 different pediatric diabetes centers participated in the study, with an age range of 7 to 16 and a diabetes duration ranging from two to 13 years. All participants had used the previous version of the closed-loop system for at least three months, and also used carbohydrate counting as a method for blood glucose control.
The virtual “camp” consisted of six hours of activities each day for three days, using the Zoom videoconferencing platform. These activities consisted of both information sessions and physical exercise, which was guided by a personal trainer. Information sessions covered aspects of using the upgraded closed-loop system, carbohydrate counting, and other aspects of diabetes management, and were led by diabetes experts, dietitians, and psychologists. Participants started using the upgraded closed-loop system immediately after the virtual camp.
Virtual “camp” linked to improvements in diabetes numbers using closed-loop technology
The researchers found that after the closed-loop system upgrade, the average amount of time in participants’ target glucose range increased — from a median of 64% to 75% after the first week. This improvement was maintained over the first three weeks of using the upgraded system, with a median time in range of 76%. Not only did the median time in range improve following the upgrade, but there was less variability between participants — meaning that those who previously had the lowest amount of time in range tended to see the greatest improvement. There were no reported adverse events (such as severely low blood glucose), and there was no increase in time spent below participants’ target glucose range following the upgrade.
The researchers noted that the study participants started out with a fairly high amount of time spent in their target glucose range, and were already using advanced diabetes technology — factors that make the improvement seen in the study even more impressive, but which also mean that the results might not apply to children in a different situation. Still, they wrote, “Closed-loop control systems, adequately supported by therapeutic education, might help to rapidly improve glycemic control” in many children with type 1 diabetes.
Want to learn more about raising a child with type 1 diabetes? Read “The Type 1 Diabetes Diagnosis,” “Type 1 Diabetes at School: What Personnel Need to Know,” and “Type 1 Diabetes and Sleepovers or Field Trips.”
Want to learn more about time in range? Read “Diabetes: Time In Range.”