Safe and effective use of a hybrid closed-loop system from diagnosis in children under 18 months with type 1 diabetes

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Tseretopoulou, Xanthippi, Viswanath, Vidya, Hartnell, Sara, Ware, Julia, Thankamony, Ajay, Webb, Emma A., Hysted, Helen, Ashford, Jennifer, Hendriks, Emile, Teoh, Yun and Williams, Rachel M. (2022) Safe and effective use of a hybrid closed-loop system from diagnosis in children under 18 months with type 1 diabetes. Pediatric Diabetes, 23 (1). pp. 90-97. ISSN 1399-543X

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Abstract

The management of type 1 diabetes in infancy presents significant challenges. Hybrid closed loop systems have been shown to be effective in a research setting and are now available for clinical use. There are relatively little reported data regarding their safety and efficacy in a real world clinical setting. We report two cases of very young children diagnosed with type 1 diabetes at ages 18 (Case 1) and 7 months (Case 2), who were commenced on hybrid closed-loop insulin delivery using the CamAPS FX™ system from diagnosis. At diagnosis, total daily dose (TDD) was 6 and 3.3 units for Case 1 and 2, respectively. Closed loop was started during the inpatient stay and weekly follow up was provided via video call on discharge. Seven months from diagnosis, Case 1 has an HbA1C of 49 mmol/mol, 61% time in range (TIR, 3.9–10 mmol/L) with 2% time in hypoglycemia (<3.9 mmol/L) with no incidents of very low blood glucose (BG; <3 mmol/L, 54 mg/dL) over 6 months. Given the extremely small TDD of insulin in Case 2, we elected to use diluted insulin (insulin aspart injection, NovoLog, Novo Nordisk Inc., Plainsboro, NJ, Diluting Medium for NovoLog®). Six months from diagnosis, the estimated HbA1c is 50 mmol/mol, TIR 76% with 1% hypoglycemia and no incidents of very low BG (<3 mmol/L, 54 mg/dL) over 6 months. We conclude that the use hybrid closed-loop can be safe and effective from diagnosis in children under 2 years of age with type 1 diabetes.

Item Type: Article
Additional Information: Data Availability Statement: Data sharing is not applicable to this article as no new data were created or analysed in this paper.
Uncontrolled Keywords: camaps fx,diabetes in infancy,hybrid closed loop systems,internal medicine,pediatrics, perinatology, and child health,endocrinology, diabetes and metabolism ,/dk/atira/pure/subjectarea/asjc/2700/2724
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Public Health
Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
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Depositing User: LivePure Connector
Date Deposited: 03 Feb 2026 16:34
Last Modified: 03 Feb 2026 17:35
URI: https://ueaeprints.uea.ac.uk/id/eprint/101830
DOI: 10.1111/pedi.13292

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