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

Olivier G Pollé1,2, Gaëlle Vermillac2, Robin Fortier3

  • 1Pediatric Diabetology and Endocrinology Unit, CHU Namur, Université Catholique de Louvain, Yvoir, Belgium.

Diabetes Technology & Therapeutics
|January 23, 2026
PubMed

Insights

Insulin dilution improved glucose control in young children with type 1 diabetes (T1D) using hybrid closed-loop (HCL) systems. This safe and effective strategy reduced glucose variability and alarms, enhancing time in range for better diabetes management.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Diseases
  • Biomedical Engineering

Background:

  • Very young children with type 1 diabetes (T1D) often experience suboptimal glucose control, even with advanced hybrid closed-loop (HCL) systems, particularly those with low total daily insulin doses (TDD).
  • Challenges in achieving target glycemic metrics necessitate exploring alternative strategies to optimize diabetes management in this vulnerable population.

Purpose of the Study:

  • To evaluate the real-world impact of using diluted insulin formulations on glucose control in very young children with T1D using an HCL system.
  • To assess the safety and efficacy of insulin dilution as an adjunct therapy for improving glycemic outcomes in pediatric T1D patients with low TDD.

Main Methods:

  • A retrospective, multicentric study involving 35 children under 6 years with T1D using the CamAPS FX HCL system.
  • Participants were transitioned from standard U100 insulin to diluted insulin (U10, U20, or U50).
  • Continuous glucose monitoring (CGM) data and clinical outcomes were analyzed pre- and post-dilution (1, 3, and 6 months) using linear mixed models.

Main Results:

  • Insulin dilution was associated with a significant reduction in time below range (TBR70), particularly overnight, and decreased glucose variability (coefficient of variation).
  • A notable increase in time in range (TIR70-180) by 1.5 hours and a decrease in time above range (TAR180) by 1 hour per day were observed.
  • No severe hypoglycemia or diabetic ketoacidosis events occurred, indicating a favorable safety profile for diluted insulin use.

Conclusions:

  • Insulin dilution represents a safe and effective strategy for improving glucose control in very young children with T1D and low TDD using HCL systems.
  • This intervention offers a practical solution to enhance glycemic management and reduce diabetes-related complications in pediatric populations struggling with suboptimal control.
Abstract

Keywords:
childdiluted insulinglucose variabilityhybrid close looptype 1 diabetesvery young children

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