A system to enhance safety of the insulin pump at night in children with type 1 diabetes

This trial examined whether suspending insulin release from the insulin pump based on predicting blood glucose levels could prevent low blood glucose levels at night.

An insulin pump allows patients with type 1 diabetes (T1D) to enter in the carbohydrate content of a meal and the pump releases insulin based on this. A continuous glucose monitor (CGM) is a device which allows patients to view their blood glucose (sugar) levels every few minutes. This device receives information about the blood glucose levels though a sensor placed underneath the skin and the device then displays the blood glucose levels on the screen.  

The insulin pump and CGM may be combined together to control blood glucose levels. However, patients using the insulin pump at night may have a hypoglycemic episode (dangerously low blood glucose levels below 3.9 mmol/L) which can lead to a seizure. If blood glucose levels decrease below 3.9 mmol/L, an alarm sounds to alert the patient and the pump stops releasing insulin.  However, the pump may not always suspend insulin release.

A new system has been developed which allows the pump to suspend insulin release if blood glucose levels are predicted to fall below 4.5 mmol/L within 30 minutes. This predictive low glucose system (PLGS) can reduce hypoglycemia at night by 74% in 15-45 year olds. Its effect has not been studied in children.

This trial aimed to determine whether predicting low blood glucose levels can suspend insulin release to reduce hypoglycemia in T1D children.

This study involved 81 T1D patients divided into 2 groups. One group were 11-14 years. The other group were 4-10 year olds. For 42 nights, participants used the insulin pump with or without the PGLS.

Hypoglycemia was reduced by 54% in 11-14 year olds and 50% in 4-10 years olds when participants used the PLGS. The average blood glucose levels at night were higher when participants used the PLGS compared to when they did not (increase of 8 mg/dL for 11-14 year olds, 7 mg/dL for 4-10 year olds).

Diabetic ketoacidosis (a condition that occurs when the cells of the body do not get enough glucose for energy and the body begins to burn fat) in the morning was similar when participants did and did not use the PLGS.

This trial concluded that a PLGS can reduce the frequency of low blood glucose levels at night, without increasing morning ketoacidosis. 

The accuracy of the sensors may have been improved to enhance the detection of hypoglycemia. 

Consult your doctor about the current state of the art technology available and whether is it suitable for you.