Overcoming Closed-Loop System Limits: Diluted Insulin Improves Glycemic Control and Reduces Nighttime Hypoglycemia in Toddlers with Low Insulin Requirements
Authors' conclusion
In very young children with T1D and low TDD who are exhibiting suboptimal glucose control despite HCL, insulin dilution may be a safe and efficient option.
Study context
- Population
- Children below 6 years of age with T1D and low total daily dose using CamAPS FX hybrid closed-loop (HCL) system, France
- Participants
- 35 participants
- Exposure
- Diluted insulin vs U100 insulin
- Outcome
- Glucose control (CGM data)
- Follow-up
- 1, 3 and 6 months postdilution
Methodological detailsmulticentre, real-world, before-after comparison, linear mixed models
- Multicentre
- Real-world
- Before-after comparison
- Linear mixed models
Main finding
As reported in the abstract
CGM glucose control
Time below range (TBR70) decrease between 4 to 7AM
3-fold
Significant increase of time in range (TIR70-180) per day
1.5 h
Decrease of time above range (TAR180) per day
1 h
Observational data: associations, not effects.
Further findings
Baseline total daily dose (TDD) · before dilution
- Median TDD before dilution
- 9.7 (7.7-11.4) UI/day
- Suboptimal glucose control before dilution
Effect by time of dilution
- Results observed independently of the time of dilution
Safety
Severe hypoglycaemia or ketoacidosis · follow-up
- Episodes of severe hypoglycemia or ketoacidosis
- 0
Original publication
Overcoming Closed-Loop System Limits: Diluted Insulin Improves Glycemic Control and Reduces Nighttime Hypoglycemia in Toddlers with Low Insulin Requirements. Diabetes Technol Ther. Published 23 January 2026. doi:10.
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