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Optimizing a Hybrid Closed Loop System in Type 1 Diabetes: A Case Report.

Goran Petrovski1, Fawziya Al Khalaf2, Khalid Hussain2

  • 1Pediatric Endocrine and Diabetes Division, Sidra Medicine, Doha, Qatar. goran.endo@gmail.com.

Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders
|July 22, 2018
PubMed
Summary

Optimizing a hybrid closed-loop (HCL) insulin pump system in a type 1 diabetes patient improved glucose control. Adjusting insulin-to-carbohydrate ratio and insulin sensitivity factor significantly reduced HbA1c and increased time in range.

Keywords:
Glucose controlHybrid closed loopOptimizationType 1 diabetes

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Area of Science:

  • Endocrinology
  • Biomedical Engineering
  • Metabolic Diseases

Background:

  • Type 1 diabetes (T1D) management requires continuous glucose monitoring and insulin delivery.
  • Hybrid closed-loop (HCL) systems aim to automate insulin delivery for improved glycemic control.
  • Previous insulin pump therapy (Medtronic Veo) in this patient showed suboptimal HbA1c levels (7.8%-10.2%).

Purpose of the Study:

  • To optimize the performance of the Minimed 670G HCL system in an 11-year-old female with T1D.
  • To evaluate the impact of HCL system optimization on glycemic control and quality of life.
  • To assess the effectiveness of adjusting key insulin pump parameters.

Main Methods:

  • Initiated Minimed 670G HCL system using prior Medtronic Veo pump settings.
  • Optimized insulin-to-carbohydrate ratio (ICHR), active insulin time, and insulin sensitivity factor (ISF) over 3 months.
  • Monitored HbA1c, time in range (TIR), sensor glucose (SG) values, sensor wear, and auto mode usage.

Main Results:

  • HbA1c decreased by 1.3%.
  • Time in range (TIR) increased to 77%.
  • Average sensor glucose (SG) was 139±60 mg/dl, with 82% sensor wear and 84% auto mode usage per week.

Conclusions:

  • Immediate adjustment of bolus wizard settings (ICHR, ISF, active insulin time) is recommended for HCL system optimization.
  • The HCL system effectively improves overall glucose control in T1D.
  • Optimization leads to increased time in sensor glucose range and reduced HbA1c levels.