Babies with type 1 diabetes can be successfully treated using an ‘artificial pancreas’, preventing dangerous consequences of very high or very low glucose levels in their blood.
The closed-loop device, invented by Cambridge-based Professor Roman Hovorka and licensed in March 2020 for use in children from more than one year old, is life-changing for patients and their families.
Now an expert team from Addenbrooke’s and the Norfolk and Norwich University Hospitals has successfully used the closed-loop system, along with diluted insulin, in a seven-month-old baby, with some parents describing the technology as “fantastic”, giving them “peace of mind”, particularly at night.
Writing in the journal Paediatric Diabetes, the authors describe training and supporting the family to prepare the diluted insulin and insert it into the pump.
Lead author and consultant in paediatric diabetes at Cambridge University Hospital (CUH), Dr Rachel Williams, said: “The artificial pancreas takes over a proportion of the daily management of the illness, although there is a still a huge burden of care for carers of very young children with diabetes even when using the most up to date technology.
By using diluted insulin, we can control blood glucose levels in a much more subtle way – avoiding highs and lows which could cause developmental problems for such a young child.
Dr Rachel Williams
“Although the artificial pancreas is currently only licensed down to one year old, we discussed all options with the family, and decided to use the closed-loop system off license. It has worked really well, and thanks to the collaboration with diabetes teams in Norwich we have been able to support this family to use it successfully.”
Dr Emma Webb, paediatric endocrinologist at Norfolk and Norwich University Hospital (NNUH), and co-author, said: “The diabetes team at NNUH has significant experience of managing children on pump therapy. However, the concept of managing a 6-month-old on a novel closed loop system was daunting.
“Working in collaboration with the CUH team to look after Millie has been a fantastic way for us to safely deliver her care closer to home. The embedding of video consultations into the NHS infrastructure as a result of the COVID-19 pandemic also helped us to learn and to deliver her care as a unified team across both sites.”
The management of very small children with type 1 diabetes is notoriously challenging and can be very difficult to achieve adequate glucose control without unacceptable rates of hypoglycaemia.
The artificial pancreas is very effective in moderating blood glucose levels. It consists of an app, known as CamAPS FX, which works with an insulin pump and a glucose monitor to automatically deliver insulin when needed.
It also uploads the data to a website so that medical teams can see real-time information about the patient’s condition. This makes it much easier to provide health advice remotely.
Dr Williams emphasised the importance of a multi-disciplinary team in looking after children with diabetes, adding: “I can’t stress enough how delivery of care would be impossible without the expertise of a team of dedicated professionals including administrative staff, dieticians, doctors, nurses, pharmacists, play specialists and psychologists.”
Around 400,000 people in the UK are affected by type 1 diabetes, 29,000 of them children. It is a chronic, life-threatening condition that has a life-long impact on those diagnosed with it and their families. Previously, people with type 1 diabetes rely on a routine of finger-prick blood tests and insulin injections or infusions just to stay alive, because their pancreas no longer produces insulin itself.
A second child of 18-months was also successfully fitted with the closed-loop system and his condition described in the journal. His parents said: “When we were first told of our son’s diagnosis, the thought of how were we going to manage this seemed a daunting challenge, and the lack of control we would have was honestly scary. The CamAPS FX™ FX closed loop system put those fears to bed very quickly.
“’The combination of the pump, continuous blood sugar monitoring along with a system to manage his blood sugar levels has been incredibly helpful. Having what is essentially another set of eyes watching over our son 24/7 is what allows us to regain part of our old lives and sleep through the night without worry.”