Closed-loop insulin delivery in end-of-life care: a case report

Area of Science:

• End-of-life care
• Diabetes management
• Medical technology

Background:

• Glucose management in terminally ill patients presents significant challenges.
• Balancing minimally invasive methods with avoiding symptomatic hypoglycemia and hyperglycemia is crucial.
• Personalized glucose targets and variable insulin needs require adaptable systems.

Observation:

• A case study involving a hospitalized patient during terminal illness utilized closed-loop insulin delivery within a randomized controlled trial.
• Continuous glucose monitoring and automated insulin delivery were employed.
• The system demonstrated safe glucose control without adverse events.

Findings:

• Mean sensor glucose was 11.3 ± 4.3 mmol/l.
• 70.5% of time was spent within the target glucose range (6-15 mmol/l).
• Time spent in hypoglycemia was 2.0%, and in significant hyperglycemia (>20 mmol/l) was 2.6%.

Implications:

• Closed-loop systems offer personalized glucose targets and adapt to fluctuating insulin needs.
• Continuous glucose sensors and insulin pump therapy are less invasive than traditional methods.
• These systems may represent a safer and more manageable option for end-of-life glucose control.