Safety and Glycemic Outcomes With a Tubeless Automated Insulin Delivery System in Very Young Children With Type 1 Diabetes: A Single-Arm Multicenter Clinical Trial.

OBJECTIVE: Very young children with type 1 diabetes often struggle to achieve glycemic targets, putting them at risk for long-term complications and creating an immense management burden for caregivers. We conducted the first evaluation of the Omnipod 5 Automated Insulin Delivery System in this population. RESEARCH DESIGN AND METHODS: A total of 80 children aged 2.0-5.9 years used the investigational system in a single-arm study for 13 weeks following 14 days of baseline data collection with their usual therapy. RESULTS: There were no episodes of severe hypoglycemia or diabetic ketoacidosis. By study end, HbA1c decreased by 0.55% (6.0 mmol/mol) (P < 0.0001). Time with sensor glucose levels in target range 70-180 mg/dL increased by 10.9%, or 2.6 h/day (P < 0.0001), while time with levels <70 mg/dL declined by median 0.27% (P = 0.0204). CONCLUSIONS: Use of the automated insulin delivery system was safe, and participants experienced improved glycemic measures and reduced hypoglycemia during the study phase compared with baseline.

Current guidelines for weight loss surgery in adolescents: a review of the literature.

INTRODUCTION: The purpose of this review was to synthesize current clinical practice guidelines for weight loss surgery in adolescents in the United States and Canada to guide pediatric nurse practitioners in decisions regarding appropriate patient referral and counseling. METHOD: A comprehensive search of the literature from 2007 until April 2013 was conducted using the PubMed, Embase, and CINAHL databases, including a hand search of references lists of identified articles. Guidelines pertaining exclusively to the use of weight loss surgery and general obesity treatment guidelines that included recommendations about weight loss surgery in adolescents were included in the review. RESULTS: Variation exists among the guidelines regarding criteria for appropriate age, body mass index, comorbidity, exclusion, and preoperative management. Validation for laparoscopic weight loss surgery techniques in adolescents is provided. DISCUSSION: Weight loss surgery for morbidly obese adolescents is a medically and psychologically complex decision, and primary care providers need to be equipped to address this decision with their patients and families.