Medical research: Insulin delivery system may aid adolescents with type 1 diabetes

A hybrid closed-loop insulin delivery system that reduces hyperglycemia and glucose variation and may improve brain development and cognitive function in adolescents with type 1 diabetes, is reported in a proof-of-concept pilot study in Nature Communications. The findings are based on results from 42 adolescents and further research is needed to explore how the system may aid the care of children with this condition.

Managing blood sugar levels in children with type 1 diabetes can be difficult and while the gold standard of clinical care is to maintain near normal glucose levels, this is difficult to achieve in practice. Type 1 diabetes is associated with alterations in brain structure and function in children, however, the extent of this effect is not well understood.

In a proof-of-concept pilot study Allan Reiss and colleagues compared the use of a hybrid closed-loop insulin delivery system with standard diabetes care (either an open-loop pump or multiple daily doses of insulin) over a 6-month period in 42 adolescents between the ages of 14–17, who had been diagnosed with type 1 diabetes before the age of 8. The adolescents underwent cognitive assessments and multi-modal brain imaging before and after the study period. The authors found that adolescents using the hybrid closed-loop system showed reductions in hyperglycaemia and glucose variation compared to those using the other treatments assessed. They also indicate that this was accompanied by changes in some of the metrics of brain structure and function measured and gains in standardised IQ scores. Based on these results the authors suggest that the brains of adolescents who used the hybrid closed-loop system developed along a more neurotypical trajectory.

The authors argue that their findings demonstrate the importance of rigorous glycaemic control throughout a child’s lifetime and that the hybrid closed-loop system may aid this. However, they caution that more research into the system and the development of the adolescent brain is needed.