ISPAD clinical practice consensus guidelines 2022: Management of children and adolescents with diabetes requiring surgery

Perioperative maintenance of hybrid closed loop insulin pump systems in youth with type 1 diabetes mellitus: A case series

“…Indeed, the inclusion of this technology represents a natural evolution from the current guidelines which support perioperative maintenance of the insulin pump in many anesthetic cases. 7,8,28 Further, in a period of environmental change where waste in health care is increasingly scrutinized, continuing hybrid closed loop systems perioperatively may lead to significant cost and resource savings by repurposing the patient's existing insulin delivery system to achieve glycemic control.…”

“…However, there is limited data regarding the use of hybrid closed loop systems in pediatric patients undergoing anesthesia and surgery 10,16 . The ISPAD recommendations acknowledge there is no evidence regarding the perioperative use of automated insulin delivery systems 8 …”

“…10,16 The ISPAD recommendations acknowledge there is no evidence regarding the perioperative use of automated insulin delivery systems. 8 We therefore describe our experiences with the perioperative use of hybrid closed loop systems in the pediatric population and present a case series of seven pediatric patients with type 1 diabetes who underwent anesthesia for procedures and minor surgery and were successfully managed with this technology. The aims of this study were twofold: (1) to assess the level of perioperative glycemic control achieved with continuation of hybrid closed loop insulin delivery systems, and (2) to assess the safety and feasibility of the perioperative use of this technology.…”

“…6 Both the Society for Pediatric Anesthesia and the International Society for Pediatric and Adolescent Diabetes (ISPAD) have published recommendations for the perioperative use of CGMs and insulin pumps. 7,8 While CGMs can be used perioperatively to follow glycemic trends, potential issues with interference from device compression, diathermy, and medications have led to the recommendation that treatment decisions to achieve a blood glucose between 90 and 180 mg/ dL be confirmed with point-of-care testing. Insulin pumps may be continued during minor procedures but should be removed for longer or major surgical cases.…”

“…Insulin pumps have also been maintained in the perioperative period and recommendations around their use suggest that glycemic control can be reliably achieved 6 . Both the Society for Pediatric Anesthesia and the International Society for Pediatric and Adolescent Diabetes (ISPAD) have published recommendations for the perioperative use of CGMs and insulin pumps 7,8 . While CGMs can be used perioperatively to follow glycemic trends, potential issues with interference from device compression, diathermy, and medications have led to the recommendation that treatment decisions to achieve a blood glucose between 90 and 180 mg/dL be confirmed with point‐of‐care testing.…”