Perioperative Use of a Hybrid Closed Loop System in an Obese Patient With Type 1 Diabetes Undergoing Metabolic Surgery: Insights Into Changes in Insulin Delivery and Sensitivity

Rodriguez-Diaz, Eduardo; Rizo, Ivania; Sullivan, Catherine; Steenkamp, Devin

doi:10.1177/1932296818784068

Cited by 4 publications

(4 citation statements)

References 2 publications

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“…This was necessary since the most recent clinical guidelines and recommendations for the management of patients with diabetes in CSII therapy undergoing surgery or anesthesia-requiring procedures focus on conventional CSII and do not take into account the more advanced HCL systems ( 1 , 2 ). A previous report on an adult patient with T1D undergoing metabolic surgery (sleeve gastrectomy) focused more on the results of the surgery itself rather than the perioperative period but helped us in the decision to program the 50% reduction in the manual-mode basal insulin delivery rates ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

“…We believe that this experience provides a starting point for a novel approach to perioperative management of children with T1D and advocate for a “take your pump to surgery” message that could be contemplated with patients and family and considered by surgical teams, under close supervision by pediatric endocrinologists. We provide a table of recommendations based on previous recommendations ( 1 , 2 ), reports ( 7 ), and our own experience ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…Since all prerequisites were fulfilled and the family gave written consent, the pediatric endocrinology team agreed to let the system run in auto-mode, under close clinical monitoring. The pump's basal rate in case the system switched to “manual mode” due to CGM loss or malfunction was adjusted to 50% of the usual dose as recommended ( 7 ). We decided to start an IV infusion of 5% dextrose, with 150 mEq/L of sodium and 20 mEq/L of potassium to prevent ketosis (see Table 1 for preparation instructions), but avoided IV insulin and checked the system's behavior overnight.…”

Section: Patient Presentationmentioning

confidence: 99%

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Hybrid Closed-Loop System Achieves Optimal Perioperative Glycemia in a Boy With Type 1 Diabetes: A Case Report

et al. 2021

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The goal in type 1 diabetes (T1D) therapy is to maintain optimal glycemic control under any circumstance. Diabetes technology is in continuous development to achieve this goal. The most advanced Food and Drug Administration- and European Medicines Agency-approved devices are hybrid closed-loop (HCL) systems, which deliver insulin subcutaneously in response to glucose levels according to an automated algorithm. T1D is frequently encountered in the perioperative period. The latest international guidelines for the management of children with diabetes undergoing surgery include specific adjustments to the patient's insulin therapy, hourly blood glucose monitoring, and intravenous (IV) insulin infusion. However, these guidelines were published while the HCL systems were still marginal. We present a case of a 9-year-old boy with long-standing T1D, under HCL system therapy for the last 9 months, and needing surgery for an appendectomy. We agreed with the family, the surgical team, and the anesthesiologists to continue HCL insulin infusion, without further adjustments, hourly blood glucose checks or IV insulin, while monitoring closely. The HCL system was able to keep glycemia within range for the total duration of the overnight fast, the surgery, and the initial recovery, without any external intervention or correction bolus. This is, to the best of our knowledge, the first reported pediatric case to undergo major surgery using a HCL system, and the results were absolutely satisfactory for the patient, his family, and the medical team. We believe that technology is ripe enough to advocate for a “take your pump to surgery” message, minimizing the impact and our interventions. The medical team may discuss this possibility with the family and patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Patient Presentationmentioning

confidence: 99%

See 1 more Smart Citation

Hybrid Closed-Loop System Achieves Optimal Perioperative Glycemia in a Boy With Type 1 Diabetes: A Case Report

et al. 2021

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“…However, there are few reported cases of using hybrid closed-loop (HCL) systems in perioperative insulin therapy. In each of these cases, the use of a hybrid closed-loop system was both safe and effective [8,9].…”

Section: Introductionmentioning

confidence: 98%

The Use of a Hybrid Closed-Loop System for Glycemic Control in Two Pediatric Patients with Type 1 Diabetes Undergoing Minor Surgery

et al. 2023

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Technological progress in the treatment of type 1 diabetes requires doctors to use modern methods of insulin therapy in all areas of medicine that patients may come into contact with, including surgical interventions. The current guidelines indicate the possibility of using continuous subcutaneous insulin infusion in minor surgical procedures, but there are few reported cases of using a hybrid closed-loop system in perioperative insulin therapy. This case presentation focuses on two children with type 1 diabetes who were treated with an advanced hybrid closed-loop (AHCL) system during a minor surgical procedure. In the periprocedural period, the recommended mean glycemia and the time in range were maintained.

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Perioperative Management of Adult Patients with Diabetes Wearing Devices: A Society for Perioperative Assessment and Quality Improvement (SPAQI) Expert Consensus Statement

Oprea,

Kalra,

Duggan

et al. 2024

Journal of Clinical Anesthesia

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Perioperative Use of a Hybrid Closed Loop System in an Obese Patient With Type 1 Diabetes Undergoing Metabolic Surgery: Insights Into Changes in Insulin Delivery and Sensitivity

Cited by 4 publications

References 2 publications

Hybrid Closed-Loop System Achieves Optimal Perioperative Glycemia in a Boy With Type 1 Diabetes: A Case Report

Hybrid Closed-Loop System Achieves Optimal Perioperative Glycemia in a Boy With Type 1 Diabetes: A Case Report

The Use of a Hybrid Closed-Loop System for Glycemic Control in Two Pediatric Patients with Type 1 Diabetes Undergoing Minor Surgery

Perioperative Management of Adult Patients with Diabetes Wearing Devices: A Society for Perioperative Assessment and Quality Improvement (SPAQI) Expert Consensus Statement

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