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It is well recognised that hybrid closed-loop insulin delivery improves glycaemic control and quality of life in older children and adolescents with type 1 diabetes, but data in very young children is limited. As a result, the majority of commercially available closed-loop systems are not licensed for use in this age-group. While challenging to manage at any age, maintaining recommended glycaemic control is particularly difficult in very young children, due to their high variability of insulin requirements and unpredictable eating and activity patterns. In this talk we discuss the specific challenges of diabetes management in very young children and how hybrid closed-loop therapy might address these. We review most recent published evidence in this age-group, including results of the longest randomised closed-loop study in very young children to date, which showed significant improvements in glycaemic control with closed-loop therapy. Finally, we identify areas for future research with regards to closed-loop technology tailored for very young children and how these might alleviate disease burden.

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Objectives: We explored parents’ experiences of using a hybrid closed-loop system (CamAPS FX) when caring for a very young child (aged 1-7 years) with type 1 diabetes to better understand how this technology can affect their own, their child’s and wider family life.

Methods: We interviewed n=33 parents of 30 children who used the closed-loop system during a randomised controlled trial (KidsAP02 study). Data were analysed using a descriptive thematic approach.

Findings: As well as highlighting clinical benefits to using the closed-loop system, parents reported wide-ranging quality-of-life benefits. Parents described sleeping better and worrying less about their child due to the system’s ability to help keep glucose in range and their own ability to remote monitor insulin and glucose data. Parents also described being better placed to get on with their own lives (e.g., returning to employment) as caregiving demands were lessened, other people felt more confident caring for their child, and parents felt more confident entrusting their child’s care to others. They also noted how their child had more opportunities to socialise with peers and experienced improved concentration and mood due to better glucose control, improved sleep and not being distracted by diabetes management tasks. Siblings also benefited from parental time and effort no longer being so focused on diabetes management.

Discussion: Our findings suggest that, alongside clincal benefits, using a closed-loop system can have life changing consequences for parents, young children with type 1 diabetes and their siblings.

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Translation of optimal diabetes outcomes from the Diabetes Control and Complications Trial and diabetes technology research to routine clinical care has been suboptimal. The Stanford Pediatric Diabetes Team designed, implemented, and iterated on a pragmatic research study: ‘Teamwork, Targets, Technology, and Tight Control (4T Program)’ with the goal of improving care after diagnosis of type 1 diabetes in pediatric patients. We hypothesized that early introduction of CGM and systematic education combined with reducing the friction of CGM analysis to allow for more timely education interventions and dose adjustments would result in improved glucose metrics and quality of life. Pilot study data will be reviewed as well as approaches to technical and financial challenges to scaling the 4T program to a larger patient population in our clinic and to share the 4T program with other diabetes centers. Future directions include systematically implementing automated insulin delivery, scaling the 4T project to a wider population within our clinic and in collaboration with external colleagues, incorporating an exercise education sub-study, and advocating for better insurance coverage for diabetes care for all.

We would like to thank the other members of the 4T Study Group for their help with this project. Study team members include: Brianna Leverenz, BS, Julie Hooper MPH, RD, Ana Cortes, BS, Franziska Bishop, MS, CDCES, Natalie Pageler, MD, Jeannine Leverenz, RN, CDCES, Piper Sagan, RN, CDCES, Anjoli Martinez-Singh, RD, CDCES, Barry Conrad RD, CDCES, Annette Chmielewski, RD, CDCES, Julie Senaldi RN, CDCES, Nora Arrizon-Ruiz, Erica Pang, BS, Carolyn Herrera, BS, Victoria Ding, MS, Rebecca Gardner, MS, Kim Clash, NP, Erin Hodgson, RD, CDCES, Johannes Ferstad BS, Ryan Pie, MS, Michael Gao, BS, Annie Chang, BS, Simrat Ghuman, PhD, Priya Prahalad MD, Ananta Addala MD, Dessi Zaharieva PhD, Korey Hood PhD, Manisha Desai PhD, Ramesh Johari PhD, David Scheinker PhD and Esli Osmanlliu, MD