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Introduction
Type 1 diabetes mellitus (T1DM) requires lifelong treatment with insulin to mimic endogenous insulin secretion from the pancreas. In order to achieve good blood glucose control, intensive regimes of insulin delivery are required.
Poor control comes with significant risk of life-threatening events such as hypoglycaemia and diabetic ketoacidosis (DKA) as well as long-term complications such as retinopathy, kidney disease and vascular disease. Children and young people (CYP) with T1DM must monitor their serum glucose concentrations (SGC) and adjust insulin administration and/or carbohydrate intake to maintain glycaemic control, attempting to mimic the physiological response to changes in SGC. Long-term control is measured using haemoglobin A1c (HbA1C) levels and time in range (time spent with SGC 3.9–10 mmol/L).1
Conventionally, insulin has been delivered by multiple daily injections of insulin (MDI) with both rapid-acting and long-acting insulin tailored to activity and food intake. Insulin pumps deliver continuous subcutaneous insulin infusion (CSII), offering an alternative to MDI, and are increasingly offered to CYP. In 2008, the National Institute for Health and Care Excellence (NICE) reviewed evidence from multiple randomised controlled trials (RCTs) and observational studies, concluding that compared with MDI, CSII has quality of life benefits for CYP with T1DM such as flexibility and autonomy as well as improved socialisation and sleep. A reduction in HbA1C levels and frequency of hypoglycaemic episodes was demonstrated in several large observational studies.1
Newer pumps can link to a continuous glucose monitor (CGM), which measures interstitial glucose via a probe into the subcutaneous tissue, and automatically respond to tissue glucose levels. These ‘hybrid closed loop systems’ (HCLS) are widespread and now NICE-approved, with recent guidance suggesting all CYP could be transitioned to HCLS by 2029. The 2023 NICE guideline regarding HCLS concludes that HCLS improve glycaemic control (when considering HbA1C levels and time in range) compared with …
Footnotes
Contributors Article conception and design: MPT, EJH; literature search: EJH; identification of cases: EJH; draft manuscript preparation: EJH; manuscript review and revision: MPT, ETA. All authors reviewed and approved the final version of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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