Diabetes technology & therapeutics · 2026
Overcoming Closed-Loop System Limits: Diluted Insulin Improves Glycemic Control and Reduces Nighttime Hypoglycemia in Toddlers with Low Insulin Requirements.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Pollé Olivier G, Vermillac Gaëlle, Fortier Robin, Ben Signor Candace, Toulorge David, Sfez Annie, Mercier Aurélie, Roudaut Veronica, Remillieux Myriam, Ingrosso Diletta, Mahaut Margaux, Besançon Alix, Arvis Laura, Godot Cécile, Tamboura Agnès, Garrec Nathalie, Mathivon Laurence, Atger Laura, Renard Emeline, Bismuth Elise, Polak Michel, Pelicand Julie, Beltrand Jacques, Perge Kevin
Аннотация
BACKGROUND AND AIM: Very young children with type 1 diabetes (T1D) and low total daily dose (TDD) struggle to achieve optimal glucose control despite hybrid closed-loop (HCL) system. The aim of the study was to evaluate the impact of diluted insulin on glucose control in a real-world setting.
METHODS: This retrospective multicentric French study included 35 children with T1D (below 6 years of age) using CamAPS FX HCL system. Participants were transitioned from U100 insulin to a diluted formulation (U10, U20, or U50). Clinical and continuous glucose monitoring (CGM) data were collected before (predilution) and at 1, 3, and 6 months postdilution. Comparisons between predilution and each postdilution period were performed using linear mixed models.
RESULTS: Participants had a median TDD of 9.7 (7.7-11.4) UI/day before dilution and a suboptimal glucose control. Insulin dilution was associated with a reduction of time below range (TBR70), glucose variability (coefficient of variation) and pump alarms during the night, with TBR70 decreasing by 3-fold between 4 to 7AM. Transition to diluted insulin led to a significant increase of time in range (TIR70-180) and a decrease of time above range (TAR180) by, respectively, 1.5 h and 1 h per day. These results were observed independently of the time of dilution. No episodes of severe hypoglycemia or ketoacidosis occurred during the follow-up.
CONCLUSIONS: In very young children with T1D and low TDD who are exhibiting suboptimal glucose control despite HCL, insulin dilution may be a safe and efficient option.
METHODS: This retrospective multicentric French study included 35 children with T1D (below 6 years of age) using CamAPS FX HCL system. Participants were transitioned from U100 insulin to a diluted formulation (U10, U20, or U50). Clinical and continuous glucose monitoring (CGM) data were collected before (predilution) and at 1, 3, and 6 months postdilution. Comparisons between predilution and each postdilution period were performed using linear mixed models.
RESULTS: Participants had a median TDD of 9.7 (7.7-11.4) UI/day before dilution and a suboptimal glucose control. Insulin dilution was associated with a reduction of time below range (TBR70), glucose variability (coefficient of variation) and pump alarms during the night, with TBR70 decreasing by 3-fold between 4 to 7AM. Transition to diluted insulin led to a significant increase of time in range (TIR70-180) and a decrease of time above range (TAR180) by, respectively, 1.5 h and 1 h per day. These results were observed independently of the time of dilution. No episodes of severe hypoglycemia or ketoacidosis occurred during the follow-up.
CONCLUSIONS: In very young children with T1D and low TDD who are exhibiting suboptimal glucose control despite HCL, insulin dilution may be a safe and efficient option.