{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T21:22:26Z","timestamp":1768771346948,"version":"3.49.0"},"reference-count":39,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,12,14]],"date-time":"2024-12-14T00:00:00Z","timestamp":1734134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Reports"],"abstract":"<jats:p>Background: Insulin pumps coupled with continuous glucose monitoring sensors use algorithms to analyze real-time blood glucose levels. This allows for the suspension of insulin administration before hypoglycemic thresholds are reached or for adaptive tuning in hybrid closed-loop systems. This longitudinal retrospective study aims to analyze real-world glycemic outcomes in a pediatric population transitioning to such devices. Methods: We evaluated children with type 1 diabetes mellitus (T1D) admitted to the Pediatric Diabetes Department from a major University Hospital in Bucharest, Romania, who transitioned to hybrid closed-loop or predictive low-glucose suspend system from either non-automated insulin pumps or multiple daily injections. The primary outcome was assessing the change in glycated hemoglobin (HbA1c) after initiating these devices. Secondary outcomes analyzed changes in glucose metrics from the 90 days prior to the baseline and follow-up visit. Results: 51 children were included (58.8% girls), the mean age was 10.3 \u00b1 3.7 years, and the mean follow-up duration was 13.2 \u00b1 4.5 months. The analyzed parameters, such as HbA1c (6.9 \u00b1 0.7% vs. 6.7 \u00b1 0.6%, p = 0.023), time in range (69.3 \u00b1 11.2% vs. 76 \u00b1 9.9%, p &lt; 0.001), time in tight range (47.4 \u00b1 10.9% vs. 53.7 \u00b1 10.7%, p &lt; 0.001), time below range (5.6 \u00b1 2.9% vs. 3.5 \u00b1 1.9%, p &lt; 0.001), time above range (25 \u00b1 11.2% vs. 20.4 \u00b1 9.4%, p = 0.001), and coefficient of variation (37.9 \u00b1 4.8% vs. 35.6 \u00b1 4.6%, p = 0.001), showed significant improvements. Conclusions: The application of these sensor-integrated insulin pumps can significantly enhance metabolic control in pediatric populations, minimizing glycemic variations to mitigate complications and enrich the quality of life.<\/jats:p>","DOI":"10.3390\/pediatric16040100","type":"journal-article","created":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T06:26:12Z","timestamp":1734416772000},"page":"1188-1199","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhanced Metabolic Control in a Pediatric Population with Type 1 Diabetes Mellitus Using Hybrid Closed-Loop and Predictive Low-Glucose Suspend Insulin Pump Treatments"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8117-3278","authenticated-orcid":false,"given":"Irina","family":"Bojoga","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Diabetes Mellitus, Nutrition and Metabolic Disorders, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Endocrinology, Diabetes Mellitus, Nutrition and Metabolic Disorders, \u201cElias\u201d University Emergency Hospital, 011461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sorin","family":"Ioacara","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes Mellitus, Nutrition and Metabolic Disorders, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Endocrinology, Diabetes Mellitus, Nutrition and Metabolic Disorders, \u201cElias\u201d University Emergency Hospital, 011461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeta","family":"Malinici","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes Mellitus, Nutrition and Metabolic Disorders, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Endocrinology, Diabetes Mellitus, Nutrition and Metabolic Disorders, \u201cElias\u201d University Emergency Hospital, 011461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Chiper","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes Mellitus, Nutrition and Metabolic Disorders, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Endocrinology, Diabetes Mellitus, Nutrition and Metabolic Disorders, \u201cElias\u201d University Emergency Hospital, 011461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia","family":"Georgescu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes Mellitus, Nutrition and Metabolic Disorders, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Endocrinology, Diabetes Mellitus, Nutrition and Metabolic Disorders, \u201cElias\u201d University Emergency Hospital, 011461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3659-4544","authenticated-orcid":false,"given":"Anca Elena","family":"Sirbu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes Mellitus, Nutrition and Metabolic Disorders, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Endocrinology, Diabetes Mellitus, Nutrition and Metabolic Disorders, \u201cElias\u201d University Emergency Hospital, 011461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona","family":"Fica","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes Mellitus, Nutrition and Metabolic Disorders, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Endocrinology, Diabetes Mellitus, Nutrition and Metabolic Disorders, \u201cElias\u201d University Emergency Hospital, 011461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S2213-8587(22)00218-2","article-title":"Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: A modelling study","volume":"10","author":"Gregory","year":"2022","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Theofilou, P., and Vlastos, D.D. (2023). The Psychological Burden of Families with Diabetic Children: A Literature Review Focusing on Quality of Life and Stress. Children, 10.","DOI":"10.3390\/children10060937"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.eprac.2023.04.007","article-title":"The Evolution of Diabetes Technology\u2014Options Toward Personalized Care","volume":"29","author":"Zahid","year":"2023","journal-title":"Endocr. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1007\/s13300-020-00831-z","article-title":"Evolution of Insulin Delivery Devices: From Syringes, Pens, and Pumps to DIY Artificial Pancreas","volume":"11","author":"Kesavadev","year":"2020","journal-title":"Diabetes Ther."},{"key":"ref_5","unstructured":"(2024, June 30). Medtronic. (21 April 2023). MiniMedTM 780G System. Medtronic Diabetes. Available online: https:\/\/www.medtronicdiabetes.com\/products\/minimed-780g-insulin-pump-system."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e074984","DOI":"10.1136\/bmjopen-2023-074984","article-title":"Dual hormone fully closed loop in type 1 diabetes: A randomised trial in the Netherlands\u2014Study protocol","volume":"13","author":"Jancev","year":"2023","journal-title":"BMJ Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1007\/s13300-023-01394-5","article-title":"A Systematic Review of Commercial Hybrid Closed-Loop Automated Insulin Delivery Systems","volume":"14","author":"Peacock","year":"2023","journal-title":"Diabetes Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1111\/dom.14273","article-title":"Hybrid closed-loop therapy: Where are we in 2021?","volume":"23","author":"Leelarathna","year":"2020","journal-title":"Diabetes, Obes. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1089\/dia.2021.0203","article-title":"Real-World Performance of the MiniMed\u2122 780G System: First Report of Outcomes from 4120 Users","volume":"24","author":"Lepore","year":"2022","journal-title":"Diabetes Technol. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1089\/dia.2023.0446","article-title":"A Peek Under the Hood: Explaining the MiniMed\u2122 780G Algorithm with Meal Detection Technology","volume":"26","author":"Grosman","year":"2024","journal-title":"Diabetes Technol. Ther."},{"key":"ref_11","unstructured":"(2024, July 10). Tandem Mobi System: Small, Powerful Automated Insulin Delivery, Available online: https:\/\/www.tandemdiabetes.com\/products\/insulin-pumps\/tandem-."},{"key":"ref_12","unstructured":"(2024, July 10). Omnipod\u00ae5 for Healthcare Provider | Omnipod. Available online: https:\/\/www.omnipod.com\/hcp\/products\/omnipod5."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1111\/dom.14214","article-title":"Patients with highly unstable type 1 diabetes eligible for islet transplantation can be managed with a closed-loop insulin delivery system: A series of N-of-1 randomized controlled trials","volume":"23","author":"Benhamou","year":"2020","journal-title":"Diabetes Obes. Metab."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Templer, S. (2022). Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.919942"},{"key":"ref_15","unstructured":"FDA (2024, July 10). FDA Clears New Insulin Pump and Algorithm-Based Software to Support Enhanced Automatic Insulin Delivery, Available online: https:\/\/www.fda.gov\/news-events\/press-announcements\/fda-clears-new-insulin-pump-and-algorithm-based-software-support-enhanced-automatic-insulin-delivery."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Bionic Pancreas Research Group (2022). Multicenter, Randomized Trial of a Bionic Pancreas in Type 1 Diabetes. N. Engl. J. Med., 387, 1161\u20131172.","DOI":"10.1056\/NEJMoa2205225"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee, ElSayed, N.A., Aleppo, G., Bannuru, R.R., Bruemmer, D., Collins, B.S., Ekhlaspour, L., Hilliard, M.E., Johnson, E.L., and Khunti, K. (2023). 14. Children and Adolescents: Standards of Care in Diabetes\u20142024. Diabetes Care, 47, S258\u2013S281.","DOI":"10.2337\/dc24-S014"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1111\/pedi.13455","article-title":"ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes","volume":"23","author":"Codner","year":"2022","journal-title":"Pediatr. Diabetes"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1089\/dia.2017.0029","article-title":"Metrics Beyond Hemoglobin A1C in Diabetes Management: Time in Range, Hypoglycemia, and Other Parameters","volume":"19","author":"Wright","year":"2017","journal-title":"Diabetes Technol. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.2337\/dc17-1600","article-title":"International Consensus on Use of Continuous Glucose Monitoring","volume":"40","author":"Danne","year":"2017","journal-title":"Diabetes Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.2337\/dci19-0028","article-title":"Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations from the International Consensus on Time in Range","volume":"42","author":"Battelino","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee, ElSayed, N.A., Aleppo, G., Bannuru, R.R., Beverly, E.A., Bruemmer, D., Collins, B.S., Cusi, K., Darville, A., and Das, S.R. (2023). Summary of Revisions: Standards of Care in Diabetes\u20142024. Diabetes Care, 47, S5\u2013S10.","DOI":"10.2337\/dc24-SREV"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee, ElSayed, N.A., Aleppo, G., Bannuru, R.R., Bruemmer, D., Collins, B.S., Ekhlaspour, L., Hilliard, M.E., Johnson, E.L., and Khunti, K. (2023). 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes\u20142024. Diabetes Care, 47, S111\u2013S125.","DOI":"10.2337\/dc24-S006"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee, ElSayed, N.A., Aleppo, G., Bannuru, R.R., Bruemmer, D., Collins, B.S., Ekhlaspour, L., Hilliard, M.E., Johnson, E.L., and Khunti, K. (2023). 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes\u20142024. Diabetes Care, 47, S11\u2013S19.","DOI":"10.2337\/dc24-S001"},{"key":"ref_25","first-page":"790","article-title":"Time in Tight Glucose Range in Type 1 Diabetes: Predictive Factors and Achievable Targets in Real-World Users of the MiniMed 780G System","volume":"47","author":"Arrieta","year":"2023","journal-title":"Diabetes Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1089\/dia.2016.0421","article-title":"Glucose Outcomes with the In-Home Use of a Hybrid Closed-Loop Insulin Delivery System in Adolescents and Adults with Type 1 Diabetes","volume":"19","author":"Garg","year":"2017","journal-title":"Diabetes Technol. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1089\/dia.2018.0264","article-title":"Safety Evaluation of the MiniMed 670G System in Children 7\u201313 Years of Age with Type 1 Diabetes","volume":"21","author":"Forlenza","year":"2019","journal-title":"Diabetes Technol. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s00592-020-01607-4","article-title":"One-year experience of hybrid closed-loop system in children and adolescents with type 1 diabetes previously treated with multiple daily injections: Drivers to successful outcomes","volume":"58","author":"Petrovski","year":"2020","journal-title":"Acta Diabetol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e15015","DOI":"10.1111\/dme.15015","article-title":"Real world use of hybrid-closed loop in children and young people with type 1 diabetes mellitus\u2014A National Health Service pilot initiative in England","volume":"40","author":"Ng","year":"2023","journal-title":"Diabet. Med."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Lunati, M.E., Morpurgo, P.S., Rossi, A., Gandolfi, A., Cogliati, I., Bolla, A.M., Plebani, L., Vallone, L., Montefusco, L., and Pastore, I. (2022). Hybrid Close-Loop Systems Versus Predictive Low-Glucose Suspend and Sensor-Augmented Pump Therapy in Patients with Type 1 Diabetes: A Single-Center Cohort Study. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.816599"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1056\/NEJMoa2210834","article-title":"Trial of Hybrid Closed-Loop Control in Young Children with Type 1 Diabetes","volume":"388","author":"Wadwa","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1056\/NEJMoa2203496","article-title":"Closed-Loop Therapy and Preservation of C-Peptide Secretion in Type 1 Diabetes","volume":"387","author":"Boughton","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e245","DOI":"10.1016\/S2589-7500(22)00020-6","article-title":"Cambridge hybrid closed-loop algorithm in children and adolescents with type 1 diabetes: A multicentre 6-month randomised controlled trial","volume":"4","author":"Ware","year":"2022","journal-title":"Lancet Digit. Health"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Bombaci, B., Passanisi, S., Alibrandi, A., D\u2019arrigo, G., Patroniti, S., Averna, S., Salzano, G., and Lombardo, F. (2022). One-Year Real-World Study on Comparison among Different Continuous Subcutaneous Insulin Infusion Devices for the Management of Pediatric Patients with Type 1 Diabetes: The Supremacy of Hybrid Closed-Loop Systems. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191610293"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"4767","DOI":"10.1111\/dom.15791","article-title":"ISPED Diabetes Study Group Time in tight range in automated insulin delivery system users: Real-world data from children and adolescents with type 1 diabetes","volume":"26","author":"Piona","year":"2024","journal-title":"Diabetes Obes. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e15333","DOI":"10.1111\/dme.15333","article-title":"Assessing the feasibility of time in tight range (TITR) targets with advanced hybrid closed loop (AHCL) use in children and adolescents: A single-centre real-world study","volume":"41","author":"Eviz","year":"2024","journal-title":"Diabet. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1007\/s00592-018-1156-5","article-title":"Recent diabetes-related mortality trends in Romania","volume":"55","author":"Ioacara","year":"2018","journal-title":"Acta Diabetol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Popoviciu, M.S., Kaka, N., Sethi, Y., Patel, N., Chopra, H., and Cavalu, S. (2023). Type 1 Diabetes Mellitus and Autoimmune Diseases: A Critical Review of the Association and the Application of Personalized Medicine. J. Pers. Med., 13.","DOI":"10.3390\/jpm13030422"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.2337\/dc19-2429","article-title":"Every Fifth Individual with Type 1 Diabetes Suffers From an Additional Autoimmune Disease: A Finnish Nationwide Study","volume":"43","author":"Harjutsalo","year":"2020","journal-title":"Diabetes Care"}],"container-title":["Pediatric Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7503\/16\/4\/100\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:55:35Z","timestamp":1760115335000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7503\/16\/4\/100"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,14]]},"references-count":39,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["pediatric16040100"],"URL":"https:\/\/doi.org\/10.3390\/pediatric16040100","relation":{},"ISSN":["2036-7503"],"issn-type":[{"value":"2036-7503","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,14]]}}}