Hybrid Closed-Loop Insulin Delivery in an Adolescent with Recurrent Diabetic Ketoacidosis: A Narrative Review of Technology, Adherence and Family Support
DOI:
https://doi.org/10.5281/zenodo.22236494Keywords:
Type 1 Diabetes, Hybrid Closed-Loop, Adolescents, Diabetic Ketoacidosis, Family SupportAbstract
Adolescence is where type 1 diabetes control reliably deteriorates, and recurrent ketoacidosis in a teenager is rarely a problem of
insulin pharmacology. Automated delivery removes some of the daily decisions. It does not remove the adolescent, the household,
or the reasons the insulin was not given.
Objectives: To review the published evidence on hybrid closed-loop insulin delivery in children and adolescents: what it achieves
in glycaemic terms, what is known about its effect in those with the poorest control, what it asks of the family, and where the
evidence stops.
Material and Methods: Narrative review of randomised and crossover trials, meta-analyses, registry analyses and psychosocial
studies indexed in PubMed and the major diabetes and paediatric journals. No new patient data were generated; every estimate
quoted is one published by the original investigators.
Results: Pooled across four randomised trials and 501 children and adolescents, of whom 323 were allocated to closed-loop
therapy, time in the target range of 70 to 180 mg/dL improved by a weighted mean difference of 10.89 percentage points (95% CI
8.22 to 13.56), and participants were more likely to reach a glycated haemoglobin below 7 per cent (risk ratio 2.61, 95% CI 1.29
to 5.28). In very young children followed for 18 months, time in target rose 8.7 percentage points to 71 per cent with a fall in
glycated haemoglobin of 0.4 per cent.
Conclusion: The glycaemic benefit is consistent, of a size that matters clinically, and reproduced across systems and age groups.
What the trials do not establish is any effect on ketoacidosis, because trial populations were largely already in reasonable control
and adolescents with recurrent ketoacidosis were generally not enrolled. The technology addresses the decisions; recurrent
ketoacidosis usually reflects something else.
Abbreviations: CGM – Continuous Glucose Monitoring, DKA – Diabetic Ketoacidosis, HbA1c – Glycated Haemoglobin, HCL –
Hybrid Closed-Loop, SAP – Sensor-Augmented Pump, TIR – Time in Range, WMD – Weighted Mean Difference.
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