[Advanced Hybrid Closed Loop (AHCL) System for Glucose Monitoring and Automatic Insulin Microinfusion in Dialysis]

Management of diabetes mellitus in hemodialysis is highly complex due to increased glycemic variability and hypoglycemic risk. The use of technologies applied to diabetes has been shown to improve glycemic control, however data in dialysis patients are limited. Purpose. To describe the efficacy and safety of the minimed 780G AHCL system in a stable hemodialysis patient and during hospitalization in the Intensive Care Unit (ICU). Case. A 47-year-old patient with chronic transplant rejection complicated by post-transplant diabetes mellitus (PTD) and chronic ischemic heart disease. He is undergoing MDI multi-injection insulin therapy with reduced compliance and the need for therapeutic adjustments in relation to hypoglycemia and daily and intradialytic glycemic variability. The use of an advanced integrated CGM+insulin pump system (AHCL) was indicated. Three-month data showed the achievement of therapeutic objectives for frail patients with comorbidities; they were also confirmed in a subsequent ICU admission for an episode of pneumonia and respiratory failure. The basal insulin requirement was adjusted automatically by the PID algorithm with daily adaptation of the insulin dose, even during hemodialysis sessions. Conclusions. The use of the AHCL system has proven to be safe, effective and flexible in achieving metabolic compensation both during dialysis and in interdialysis periods and also during a severe acute episode, with excellent control of glycemic values ​​during the same.