Dr. Martin Tauschmann
MedUni Wien RESEARCHER OF THE MONTH May 2020
Closing the loop – the Artificial Pancreas in very young children with type 1 diabetes
Despite advances in the management of type 1 diabetes (T1D) and supporting technologies, the majority of children with T1D are unable to achieve recommended treatment targets. Over the past decade, considerable progress has been made in the development of closed-loop (CL) insulin delivery systems (the artificial pancreas), which couple continuous glucose monitoring and autonomous algorithm-directed insulin delivery via insulin pumps based on real-time sensor glucose levels. CL systems have been tested in a broad range of people with T1D (1-5). However, evidence in very young children is sparse (1,5). The present study is part of the KidsAP project funded by the European Commission’s Horizon 2020 Framework Programme. The multinational, multi-centre project assesses the ability of CL insulin delivery to improve glucose control in children aged 1 to 7 years. In the present pilot study, the aim was to evaluate the feasibility and safety of CL insulin delivery in this age group as well as evaluate the role of diluted insulin on glucose control (6). In an open-label, randomised, two-period crossover design, 24 children underwent two 21-day periods of unrestricted living contrasting CL with diluted insulin (U20) and CL with standard strength insulin (U100). During both interventions, the Cambridge model predictive control algorithm was used (4). The study demonstrated the feasibility and safety of CL application in this vulnerable population. The use of diluted insulin during CL did not provide additional benefits compared with standard strength insulin. Results of this pilot trial have fed into the design of the main KidsAP outcome study, which is still ongoing.
- Tauschmann M, Hovorka R. Technology in the management of type 1 diabetes – present status and future prospects. Nat Rev Endocrinol. 2018 Aug;14(8):464-475
- Tauschmann M, Thabit H, Bally L, Allen JM, Hartnell S, Wilinska ME et al. Closed-loop insulin delivery in suboptimally controlled type 1 diabetes: a multicentre, 12-week randomised trial. Lancet. 2018 Oct 13;392(10155):1321-1329
- Tauschmann M, Allen JM, Wilinska ME, Thabit H, Acerini CL, Dunger DB, Hovorka R. Home Use of Day-and-night hybrid closed-loop insulin delivery in suboptimally controlled adolescents with type 1 diabetes: A 3-week, free-living, randomized crossover trial. Diabetes Care. 2016 Nov; 39(11):2019-2025.
- Thabit H*, Tauschmann M*, Allen JM, Leelarathna L, Hartnell S, Wilinska ME et al. Home use of an artificial beta cell in type 1 diabetes. N Engl J Med. 2015 Nov 26;373(22):2129-40.*Dr. Thabit and Dr. Tauschmann contributed equally to this article.
- Bekiari E, Kitsios K, Thabit H, Tauschmann M, Athanasiadou E, Karagiannis T et al. Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis. BMJ. 2018 Apr 18;361:k1310. doi: 10.1136/bmj.k1310.