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Aim: To assess the safety and efficacy of hybrid closed‐loop (HCL) insulin delivery 24/7 versus only evening and night (E/N), and on extended 24/7 use, in free‐living children with type 1 diabetes. Materials and Methods: Prepubertal children (n = 122; 49 females/73 males; age, 8.6 ± 1.6 years; diabetes duration, 5.2 ± 2.3 years; insulin pump use, 4.6 ± 2.5 years; HbA1c 7.7% ± 0.7%/61 ± 5 mmol/mol) from four centres were randomized for 24/7 versus E/N activation of the Tandem Control‐IQ system for 18 weeks. Afterwards, all children used the activated system 24/7 for 18 more weeks. The primary outcome was the percentage of time spent in the 70‐180 mg/dL glucose range (TIR). Results: HCL was active 94.1% and 51.1% of the time in the 24/7 and E/N modes, respectively. TIR from baseline increased more in the 24/7 versus the E/N mode (52.9% ± 9.5% to 67.3% ± 5.6% [+14.4%, 95% CI 12.4%‐16.7%] vs. 55.1% ± 10.8% to 64.7% ± 7.0% [+9.6%, 95% CI 7.4%‐11.6%]; P =.001). Mean percentage time below range was similarly reduced, from 4.2% and 4.6% to 2.7%, and the mean percentage time above range decreased more in the 24/7 mode (41.9% to 30.0% [–11.9%, 95% CI 9.7%‐14.6%] vs. 39.8% to 32.6% [–7.2%, 95% CI 5.0%‐9.9%]; P =.007). TIR increased through the whole range of baseline levels and always more with 24/7 use. The results were maintained during the extension phase in those initially on 24/7 use and improved in those with initial E/N use up to those with 24/7 use. Neither ketoacidosis nor severe hypoglycaemia occurred. Conclusions: The current study shows the safety and efficacy of the Tandem Control‐IQ system in free‐living children with type 1 diabetes for both E/N and 24/7 use; 24/7 use shows better outcomes, sustained for up to 36 weeks with no safety issues. [ABSTRACT FROM AUTHOR]

Aim: To compare the efficacy of three strategies for real‐time continuous glucose monitoring (RT‐CGM) over 12 months in children and adolescents with type 1 diabetes. Methods: A French multicenter trial (NCT00949221) with a randomized, controlled, prospective, open, and parallel‐group design was conducted. After 3 months of RT‐CGM, patients were allocated to one of three groups: return to self‐monitoring of blood glucose, continuous CGM (80% of the time), or discontinuous CGM (40% of the time). The primary outcome was hemoglobin A1c (HbA1c) levels from 3 to 12 months. The secondary outcomes were acute metabolic events, hypoglycemia, satisfaction with CGM and cost. Results: We included 151 subjects, aged 2 to 17 years, with a mean HbA1c level of 8.5% (SD0.7; 69 mmol/mol). The longitudinal change in HbA1c levels was similar in all three groups, at 3, 6, 9 and 12 months. The medical secondary endpoints did not differ between groups. The rate of severe hypoglycemia was significantly lower than that for the pretreatment year for the entire study population. Subjects reported consistent use and good tolerance of the device, regardless of age or insulin treatment. The use of full‐time RT‐CGM for 3 months costs the national medical insurance system €2629 per patient. Conclusion: None of the three long‐term RT‐CGM strategies evaluated in pediatric type 1 diabetes was superior to the others in terms of HbA1c levels. CGM‐use for 3 months decreased rates of severe hypoglycemia. Our results confirm the feasibility of long‐term RT‐CGM‐use and the need to improve educational support for patients and caregivers. [ABSTRACT FROM AUTHOR]

This randomized control trial investigated glucose control with closed‐loop (CL) versus threshold‐low‐glucose‐suspend (TLGS) insulin pump delivery in pre‐pubertal children with type 1 diabetes in supervised hotel conditions. The patients [n = 24, age range: 7‐12, HbA1c: 7.5 ± 0.5% (58 ± 5 mmol/mol)] and their parents were admitted twice at a 3‐week interval. CL control to range or TLGS set at 3.9 mmoL/L were assessed for 48 hour in randomized order. Admissions included three meals and one snack, and physical exercise. Meal boluses followed individual insulin/carb ratios. While overnight (22:00‐08:00) per cent continuous glucose monitoring (CGM) time below 3.9 mmol/L (primary outcome) was similar, time in ranges 3.9 to 10.0 and 3.9 to 7.8 mmoL/L and mean CGM were all significantly improved with CL (P < 0.001). These results were confirmed over the whole 48 hour. Disconnections between devices and limited accuracy of glucose sensors in the hypoglycaemic range appeared as limiting factors for optimal control. CL mode was well accepted while fear of hypoglycaemia was unchanged. CL did not minimize nocturnal hypoglycaemia exposure but improved time in target range compared to TLGS. Although safe and well‐accepted, CL systems would benefit from more integrated devices. [ABSTRACT FROM AUTHOR]

Abstract: Aim:Hypothesis: To study the prevalence of hypercholes-terolemia, hypertriglyceridemia and the relationship between metabolic control, pubertal status and plasma lipoprotein levels in children with diabetes mellitus. Subjects and methods: A cross-sectional study was conducted on 126 subjects with type I diabetes followed at our institution. There were 57 boys and 69 girls (mean age: 13.493.4 yr; mean duration of diabetes: 7.392.1 yr), on whom fasting lipoprotein levels and pubertal status were determined. Mean glycated hemoglobin (HbA1c) of the preceed-ing year was used in the analysis. Cholesterol (CT) and triglyceride (TG) levels were transformed into standard deviations (SD) using age dependent normal values. Results: 1) CT levels of DM children (mean level: 0.991.2 SD) are higher for both sexes and at each age. Sixteen percent of the cases had CT level ]2 SD. Within the range of the HbA1c observed (9.1 9 1.2%), CT levels are not correlated with the degree of metabolic con-trol. In contrast to non-diabetic children, CT levels of the diabetic children did not vary throughout pubertal stages. CT levels correlated highly with apolipoprotein B (r 0.79; pB0.00001 and r 2 82%, in univariate and multivariate analysis, respectively. 2) Plasma TG levels are comparable in the diabetic children (mean level: 0.1190.9 SD) and non-diabetic children. Only 5% of the diabetic children have a TG level ]2 SD. The TG levels are significantly, but weakly, positively correlated with duration of diabetes and the degree of metabolic con-trol (r 2 12% and 16%, respectively, pB0.0001 for both). Conclusions: Plasma CT levels of type I diabetic children are increased in comparison to non-diabetic children and do not follow the usual decreasing pattern during puberty. [ABSTRACT FROM AUTHOR]