title: Closed-loop in children with type 1 diabetes: specific challenges.
abstract: OBJECTIVE
  To review challenges and opportunities related to closed-loop glucose control in children with type 1 diabetes (T1D).
  
  
  METHODS
  During closed-loop glucose control, insulin infusion rates on a subcutaneous insulin pump are adjusted by a control algorithm according to subcutaneous glucose sensor readings. A literature review is performed and personal experience of work with closed-loop systems at the University of Cambridge, UK, is presented.
  
  
  RESULTS
  The main challenges in the management of T1D in children are identified together with a summary of current therapeutics options. Review of the literature recognises hypoglycaemia as a limiting factor for the attainment of optimal glycaemic control, primarily in children. Additional specific confounding issues include unpredictable eating and exercise patterns especially in the youngest age group. Closed-loop systems might be particularly helpful, but have to consider increased insulin sensitivity, lower insulin doses, and human factors such as size and usability of closed-loop components.
  
  
  CONCLUSIONS
  Closed-loop systems may represent an alternative treatment option to achieve target glucose levels whilst reducing the risk of hypoglycaemia in children with T1D.
authors.affiliation: Department of Paediatrics, Uniuersity of Cambridge, Hills Road, Cambridge CB2 OQQ, UK.
authors.forename: Daniela
authors.initials: D
authors.lastname: Elleri
authors.forename: Janet M
authors.initials: JM
authors.lastname: Allen
authors.forename: David B
authors.initials: DB
authors.lastname: Dunger
authors.forename: Roman
authors.initials: R
authors.lastname: Hovorkea
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007332:Insulin Infusion Systems
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin