{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T03:49:30Z","timestamp":1792900170346,"version":"4.5.0"},"reference-count":40,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Technology &amp; Therapeutics"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background and aim:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Participants had a median TDD of 9.7 (7.7\u201311.4) UI\/day before dilution and a suboptimal glucose control. Insulin dilution was associated with a reduction of time below range (TBR\n                      <jats:sub>70<\/jats:sub>\n                      ), glucose variability (coefficient of variation) and pump alarms during the night, with TBR\n                      <jats:sub>70<\/jats:sub>\n                      decreasing by 3-fold between 4 to 7AM. Transition to diluted insulin led to a significant increase of time in range (TIR\n                      <jats:sub>70\u2013180<\/jats:sub>\n                      ) and a decrease of time above range (TAR\n                      <jats:sub>180<\/jats:sub>\n                      ) 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15209156251414981","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T10:22:18Z","timestamp":1769163738000},"page":"697-707","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Overcoming Closed-Loop System Limits: Diluted Insulin Improves Glycemic Control and Reduces Nighttime Hypoglycemia in Toddlers with Low Insulin Requirements"],"prefix":"10.1177","volume":"28","author":[{"given":"Olivier G.","family":"Poll\u00e9","sequence":"first","affiliation":[{"name":"Pediatric Diabetology and Endocrinology Unit, CHU Namur, Universit\u00e9 Catholique de Louvain, Yvoir, Belgium."},{"name":"Department of Pediatric Endocrinology, Gynecology and Diabetology, Assistance Publique-H\u00f4pitaux de Paris, Necker Enfants Malades Hospital, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ga\u00eblle","family":"Vermillac","sequence":"additional","affiliation":[{"name":"Department of Pediatric Endocrinology, Gynecology and Diabetology, Assistance Publique-H\u00f4pitaux de Paris, Necker Enfants Malades Hospital, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Fortier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital of Nice-Lenval Hospital, Nice, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candace","family":"Ben Signor","sequence":"additional","affiliation":[{"name":"Pediatrics Department, University Hospital, Dijon, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Toulorge","sequence":"additional","affiliation":[{"name":"Pediatric and Adolescent Department, Centre Hospitalier Gonesse, Gonesse, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Sfez","sequence":"additional","affiliation":[{"name":"Pediatric and Adolescent Department, Grand H\u00f4pital de l\u2019Est Francilien, Marne-la-Vall\u00e9e, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aur\u00e9lie","family":"Mercier","sequence":"additional","affiliation":[{"name":"Pediatric and Adolescent Department, Centre Hospitalier Beauvais, Beauvais, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Roudaut","sequence":"additional","affiliation":[{"name":"Pediatric and Adolescent Department, Centre 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