Boston ADA.

The artificial pancreas (AP) for children and adolescents is not a reality. Not yet. But closed loop technology is improving and moving toward. Many investigators see device submission and approval as a matter of time.

One of the most exciting things in the AP world in the last year is taking these studies out of the hospital into the outpatient setting, dicussed at a meeting on Saturday. The preliminary results are very encouraging, we have wonderful exciting devices  and they are managing kids very well, according to Stuart Weinzimer, Yale Univ, US.

Closed loop technology has been specifically designed for and validited in adults and they not be suited for pediatric use, he said. You can not assume that it works for children, he said, there are specific clinical and technical differences in pediatric devices.

Technologies and trials are much more complex for kids because children are so more much complex in their need than adults. They varued more in their insulin needs thanmost  adults because their eating and activity schedules are more variable, 

Other studies, Laurel Messer, clinical researchg nurse, Univ Colorado, US, has more than 6000 nights of AP nights of data including user experience from children, adolescents, and adults using predictive low glucose and other closed loop devices.

Human factor issue

Dozens of studies on AP, but only 4 publications talk about the human-factor piece, said Messer, and they have now started to look at the pediatric patient behaviours, including how often they check their blood glucose during AP use. It is very important to undersatnd how different age groups use the technology when they are sent home with it, she said. For the youngest patients, adoption may be slow because their parents are slow to trust the technology – they are afraid of hypoglycemia during the night especially, Adolscents are more acceptingthe new technology – but also more likely to forget to change sensors and refill reservoirs.

AP is not an implant-it-and forget-it-system and it will not be in every patient´s hand for anumber of years, No matter how finely we tune the technolocy piece, the human factor willmake the real difference. People will still havet o be very vigilant that their sensor is calibrated well, that they haveenough insulin, and that all the pieces are working together in good order. Patient burder will decrease as a stepwise process, she said.

Children have less body mass index and less fat than adults, which can make adifference in device design as well as in sensing and delivery parameters. Children are also far more active than adults and far more likely to bump and hang their devices as well as themselves. The ability of a child to understand the device, use it appropriately, interact withh the alarms, and maintain it changes dramatically with age.

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