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Editorial Diabetes Diabetes Technology and Therapy in the Pediatric Age Group Gregory P Forlenza and David Maahs Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Denver, US Abstract Recent data from the Type 1 Diabetes Exchange has highlighted the urgent need for better glycemic control in the pediatric age group. Fortunately, ongoing research on insulin pumps, continuous glucose monitors, and artificial pancreas systems continues to improve our ability to manage type 1 diabetes in all age groups, while reducing the burden of care at the same time. Here we discuss the status of diabetes technology research as well as future directions and goals of these projects. Keywords Type 1 diabetes, pediatrics, insulin pump, continuous glucose monitoring (CGM), artificial pancreas Disclosure: Gregory P Forlenza has received research funding from Medtronic Diabetes and is a consultant for Abbott Diabetes Care. David Maahs is on the advisory board for Insulet, consults for Abbott Diabetes Care, and his institution has received support from Medtronic, Dexcom, and Roche. This article is a short opinion piece and has not been submitted to external peer reviewers. No funding was received in the publication of this article. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: March 9, 2016 Published Online: April 15, 2016 Citation: US Endocrinology 2016;12(1):22–3 Correspondence: Gregory P Forlenza, University of Colorado Denver, Barbara Davis Center for Childhood Diabetes, 1775 Aurora Court, A140, Aurora, CO 80045, US. E: Gregory.Forlenza@ucdenver.edu Recent developments in diabetes technology— CSII, AP and CGM We are currently in an extremely exciting time for diabetes technology which holds near-term promise to substantially improve the lives of children with type 1 diabetes (T1D). Recent data published by the Type 1 Diabetes Exchange confirms what clinical experience has shown for years, that diabetes control among adolescents and young adults is suboptimal and better tools are needed to improve care in this age group. 1,2 Continuous subcutaneous insulin infusion (CSII) pump therapy has emerged over the past decade as a vital tool for improved diabetes care with usage rates approaching 50% of pediatric T1D patients in the US and numerous studies showing improved quality of life, decreased rates of severe hypoglycemia, improved glycated hemoglobin (A 1c ) values and decreased incidence of diabetic ketoacidosis (DKA) in patients using CSII. 3–8 Continuous glucose monitoring (CMG) has also seen dramatic improvements in the past three years, with increased sensor accuracy, decreased alarm fatigue and development of remote cell phone-based monitoring all contributing to a likely inflection point in patient uptake and use of this technology. 9–11 The ultimate goal of this line of research, however, is integration of CGM and continuous insulin delivery into a closed-loop artificial pancreas (AP) system. In such a system, insulin delivery is controlled by an automated closed-loop control algorithm. Systems may be hybrid-closed loop systems, which still require meal announcement from the patient, or fully closed loop with minimal user input required. These systems may also be either insulin only or dual-hormone, with a second counter-regulatory 22 agent included such as glucagon. The past two years have shown dramatic progress on the pathway towards commercially available AP systems. 12–14 Studies have been published for three-day to three- month periods in adults, adolescents, and children in clinical, camp, and at-home settings. 15–23 These studies demonstrate that AP technology does not simply lower glycemic targets but rather tightens glycemia, thereby producing lower average glucose values with decreased time in the hypoglycemic range. Use of these devices can thus be seen to improve glycemic control while at the same time increasing safety for patients with T1D. Upcoming diabetes technology studies The next phase of AP development involves moving from small, short term, highly supervised studies to real-world trials where several hundred participants wear these devices for three to six months in an outpatient setting. Kropoff and DeVries recently published an excellent update on these upcoming studies. 12 Among these pivotal, safety, and efficacy phase II and III studies are one industry pivotal study by Medtronic and multiple academic studies with systems under development at University of Cambridge, University of Virginia, Boston University, Stanford, Rensselear Polytechnic Institute, and the Sansum Diabetes Center. In addition multiple device manufacturers have proposed upcoming trials on next generation systems including Animas, Bigfoot Biomedical, and Tandem. These projects range from predictive low glucose suspend, to hypoglycemia- hyperglycemia minimization, to hybrid-closed loop systems with single and dual hormone designs. Projections for commercial availability of these systems are as soon as late 2016 to 2018. 12 TOUCH ME D ICA L ME D IA