Insulin delivery and nocturnal glucose control in children and adolescents with type 1 diabetes

$\textbf{Introduction:}$ Nocturnal glucose control remains challenging in children and adolescents with type 1 diabetes due to highly variable overnight insulin requirements. The issue may be addressed by glucose responsive insulin delivery based on real-time continuous glucose measurements. $\textbf{Areas covered:}$ This review outlines recent developments of glucose responsive insulin delivery systems from a paediatric perspective. We cover threshold-based suspend application, predictive low glucose suspend, and more advanced single hormone and dual-hormone closed-loop systems. Approaches are evaluated in relation to nocturnal glucose control particularly during outpatient randomised controlled trials. $\textbf{Expert opinion:}$ Significant progress translating research from controlled clinical centre settings to free-living unsupervised home studies have been achieved over the past decade. Nocturnal glycaemic control can be improved whilst reducing the risk of hypoglycaemia with closed-loop systems. Following the US regulatory approval of the first hybrid closed-loop system in non-paediatric population, large multinational closed-loop clinical trials and pivotal studies including paediatric populations are underway or in preparation to facilitate the use of closed-loop systems in clinical practice.EC Horizon 2020 [H2020-SC1-731560], JDRF [2-SRA-2014-256-M-R], National Institute of Diabetes and Digestive and Kidney Diseases [1UC4DK108520-01], National Institute for Health Research Cambridge Biomedical Research Centre, Wellcome Trust Strategic Award [100574/Z/12/Z], Efficacy and Mechanism Evaluation National Institute for Health Research [14/23/09]