Insulin delivery and nocturnal glucose control in children and adolescents with type 1 diabetes
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Authors
Hovorka, R
Tauschmann, M
Publication Date
2017-12Journal Title
Expert Opinion on Drug Delivery
ISSN
1742-5247
Publisher
Taylor & Francis
Language
English
Type
Article
This Version
AM
Metadata
Show full item recordCitation
Hovorka, R., & Tauschmann, M. (2017). Insulin delivery and nocturnal glucose control in children and adolescents with type 1 diabetes. Expert Opinion on Drug Delivery https://doi.org/10.1080/17425247.2017.1360866
Abstract
$\textbf{Introduction:}$ Nocturnal glucose control remains challenging in children and adolescents with type 1 diabetes due to highly variable overnight insulin requirements. The issue may be addressed by glucose responsive insulin delivery based on real-time continuous glucose measurements.
$\textbf{Areas covered:}$ This review outlines recent developments of glucose responsive insulin delivery systems from a paediatric perspective. We cover threshold-based suspend application, predictive low glucose suspend, and more advanced single hormone and dual-hormone closed-loop systems. Approaches are evaluated in relation to nocturnal glucose control particularly during outpatient randomised controlled trials.
$\textbf{Expert opinion:}$ Significant progress translating research from controlled clinical centre settings to free-living unsupervised home studies have been achieved over the past decade. Nocturnal glycaemic control can be improved whilst reducing the risk of hypoglycaemia with closed-loop systems. Following the US regulatory approval of the first hybrid closed-loop system in non-paediatric population, large multinational closed-loop clinical trials and pivotal studies including paediatric populations are underway or in preparation to facilitate the use of closed-loop systems in clinical practice.
Keywords
threshold-based insulin interruption, low glucose suspension, predictive low glucose suspension, artificial pancreas, closed-loop system, type 1 diabetes, control algorithm, insulin pump, continuous glucose monitor
Sponsorship
EC Horizon 2020 [H2020-SC1-731560], JDRF [2-SRA-2014-256-M-R], National Institute of Diabetes and Digestive and Kidney Diseases [1UC4DK108520-01], National Institute for Health Research Cambridge Biomedical Research Centre, Wellcome Trust Strategic Award [100574/Z/12/Z], Efficacy and Mechanism Evaluation National Institute for Health Research [14/23/09].
Funder references
National Institute for Health Research (NIHR) (unknown)
Wellcome Trust (100574/Z/12/Z)
Juvenile Diabetes Research Foundation Ltd (JDRF) (2-SRA-2014-256-M-R)
European Commission Horizon 2020 (H2020) Societal Challenges (731560)
National Institute of Diabetes and Digestive and Kidney Diseases (UC4DK108520)
Identifiers
External DOI: https://doi.org/10.1080/17425247.2017.1360866
This record's URL: https://www.repository.cam.ac.uk/handle/1810/266918
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