UK Study: Closed-Loop Insulin Pumps Deliver Lasting Results in Very Young Children With Type 1 Diabetes

A study from the United Kingdom, conducted by researchers at the Institute of Metabolic Science-Metabolic Research Laboratories at the University of Cambridge, offers encouraging long-term data for one of the most vulnerable and difficult-to-manage groups in diabetes care: toddlers and very young children. The research, published in Diabetes Care in 2024, evaluated the safety and effectiveness of hybrid closed-loop (CL) insulin pump therapy in children aged just 1 to 7 years over an 18-month period.

What Is a Hybrid Closed-Loop System?

A hybrid closed-loop system — sometimes called an "artificial pancreas" — combines a continuous glucose monitor (CGM) with an insulin pump. The system automatically adjusts insulin delivery based on real-time blood sugar readings, reducing the burden on parents and caregivers to manually calculate and administer doses around the clock. The Cambridge system used in this study is similar in concept to commercially available systems in the U.S., such as Medtronic's MiniMed and Tandem's Control-IQ.

What the Study Found

Following an initial 16-week randomized trial comparing CL therapy to sensor-augmented pump (SAP) therapy across 74 young children, 49 participants (average age 6.6 years) continued using the closed-loop system for an additional 18 months.

The results were notable:

• Time in Range (TIR) improved by 8.4 percentage points compared to the sensor-augmented pump period. Children spent 70% of their time with blood sugar in the healthy range of 70–180 mg/dL (converted from 3.9–10.0 mmol/L).
• HbA1c averaged 6.7% at 18 months — well below the American Diabetes Association's (ADA) recommended target of under 7.5% for children under 6 and under 7% for older children.
• Hypoglycemia rates (blood sugar below 70 mg/dL) did not increase compared to either the SAP or earlier CL period — a critical safety finding for this age group.
• Improvements were sustained across the full 18 months, with no meaningful decline in performance over time.

How This Compares to US Guidelines

The ADA currently recommends a TIR goal of at least 70% for most people with Type 1 diabetes. This study's participants hit that benchmark precisely — a remarkable outcome for children this young, whose blood sugar levels are notoriously unpredictable due to irregular eating, activity, and growth spurts. The ADA also endorses closed-loop systems as an effective management tool, and this UK data strengthens the evidence base for their use even in the very youngest patients.

Why This Matters for US Patients

For American families managing Type 1 diabetes in toddlers and preschool-aged children, this research is a meaningful step forward. Managing T1D in children under 7 is exceptionally challenging — young children cannot reliably communicate symptoms of low blood sugar, and caregivers often face sleepless nights of manual glucose checks. This long-term UK data demonstrates that closed-loop technology can provide sustained, safe glycemic control in this age group, potentially reducing the physical and emotional burden on entire families. Parents and pediatric endocrinologists in the US should discuss whether an FDA-cleared closed-loop system may be appropriate, as several options are available or in late-stage approval for young children.

Study Citation

Ware J, Allen C, Boughton CK, et al. Eighteen-Month Hybrid Closed-Loop Use in Very Young Children With Type 1 Diabetes: A Single-Arm Multicenter Trial. Diabetes Care. 2024. PMID: 39418532. DOI: 10.2337/dc24-1313