What question did this study set out to answer?

To evaluate the effect of diluted insulin on glucose control in very young children with type 1 diabetes using a hybrid closed-loop system.

January 25, 2026

Overcoming Closed-Loop System Limits: Diluted Insulin Improves Glycemic Control and Reduces Nighttime Hypoglycemia in Toddlers with Low Insulin Requirements

Key Points

To evaluate the effect of diluted insulin on glucose control in very young children with type 1 diabetes using a hybrid closed-loop system.
Retrospective multicentric study in France involving 35 children under 6 years with type 1 diabetes.
Transition from U100 insulin to diluted insulin formulations (U10, U20, U50).
Collection of clinical and continuous glucose monitoring data before and at 1, 3, and 6 months postdilution.
Statistical analysis using linear mixed models to compare glucose control metrics pre- and post-dilution.
Median total daily dose of insulin was 9.7 UI/day prior to dilution, with suboptimal glucose control observed.
Diluted insulin significantly reduced time below range and glucose variability during nighttime.
Time in range increased by 1.5 hours per day, while time above range decreased by 1 hour per day.
No severe hypoglycemia or ketoacidosis episodes were reported during follow-up.

Abstract

Background and aim: Very young children with type 1 diabetes (T1D) and low total daily dose (TDD) struggle to achieve optimal glucose control despite hybrid closed-loop (HCL) system. The aim of the study was to evaluate the impact of diluted insulin on glucose control in a real-world setting. Methods: This retrospective multicentric French study included 35 children with T1D (below 6 years of age) using CamAPS FX HCL system. Participants were transitioned from U100 insulin to a diluted formulation (U10, U20, or U50). Clinical and continuous glucose monitoring (CGM) data were collected before (predilution) and at 1, 3, and 6 months postdilution. Comparisons between predilution and each postdilution period were performed using linear mixed models. Results: Participants had a median TDD of 9.7 (7.7–11.4) UI/day before dilution and a suboptimal glucose control. Insulin dilution was associated with a reduction of time below range (TBR 70 ), glucose variability (coefficient of variation) and pump alarms during the night, with TBR 70 decreasing by 3-fold between 4 to 7AM. Transition to diluted insulin led to a significant increase of time in range (TIR 70–180 ) and a decrease of time above range (TAR 180 ) by, respectively, 1.5 h and 1 h per day. These results were observed independently of the time of dilution. No episodes of severe hypoglycemia or ketoacidosis occurred during the follow-up. Conclusions: 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.

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Cite This Study

Pollé et al. (Fri,) studied this question.

synapsesocial.com/papers/6975b2aefeba4585c2d6e243 https://doi.org/https://doi.org/10.1177/15209156251414981

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