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

Abstract

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.

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

“…To our knowledge, this is the largest case series of hybrid closed loop system use in the perioperative period in pediatric patients, and the first to discuss some of the newer hybrid closed loop systems. 16 While BG management was appropriate during these cases, we found that patients who initiated exercise activity mode on t:slim Control-IQ the night before surgery arrived to the preoperative area with higher BG. Based on this experience, we recommend initiating exercise activity mode (t:slim) or activity feature (Omnipod 5) upon arrival to the preoperative area before the procedure, allowing a shorter period of time at a higher target BG.…”

“…To our knowledge, this is the largest case series of hybrid closed loop system use in the perioperative period in pediatric patients, and the first to discuss some of the newer hybrid closed loop systems 16 . While BG management was appropriate during these cases, we found that patients who initiated exercise activity mode on t:slim Control‐IQ the night before surgery arrived to the preoperative area with higher BG.…”

“…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 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.…”

“…With increasing use of these advanced diabetes technologies among individuals with diabetes, it is inevitable that providers will encounter hybrid closed loop systems in all settings, including the perioperative space. 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 …”

Safety, Metabolic and Psychological Outcomes of Medtronic MiniMed 780G™ in Children, Adolescents and Young Adults: A Systematic Review

“…During the periprocedural periods, glucose levels remained within the target range. AHCL reports on the day of the surgical procedure were very similar to those 2 weeks prior to hospital admissions and revealed CGM metrics within the recommended clinical targets [ 45 ]. A case study of an 11-year-old subject with T1D from Saudi Arabia reported that AHCL provided satisfactory glucose control during fasting for more than 14 h per day, which is typical during the month of Ramadan.…”