Advanced Hybrid Closed-Loop Systems in Perioperative Care: Safety During Anesthesia

There is limited evidence regarding the safety and efficacy of advanced hybrid closed-loop (AHCL) systems during the perioperative period. Specific management guidelines for these systems are lacking.

To describe glycemic control metrics in patients with AHCL system during the intraoperative and postoperative periods.

Analytical study based on a prospective cohort of adults with type 1 diabetes (T1D) or type 2 diabetes who are treated with AHCL system (MiniMed™780G, Medtronic, USA) and are undergoing surgical procedures. The study compared time in range (%TIR) between 70 and 180 mg/dL, time below range (%TBR) <70 and <54 mg/dL, time above range (%TAR) >180 and >250 mg/dL, and time in normoglycemia range (%TINR) between 70 and 140 mg/dL during the intraoperative, immediate postoperative, and late postoperative periods, with baseline measurements.

The analysis included 15 patients (86% T1D; 55.4 ± 16.3 years) and 17 surgical procedures (70% elective; mean duration 65.3 ± 36.3 min). Baseline data obtained 24 h prior to the admission: %TIR 78.4 ± 17.5%, %TINR 58.6 ± 22.9%, and %TBR <70 mg/dL 3.7 ± 4.2%. During the intraoperative period, %TIR increased to 99.6 ± 1.5% (P < 0.001), and %TBR <70 mg/dL decreased to 0 (P < 0.001). %TAR >180 mg/dL decreased from 17.8 ± 16.8% to 0.1 ± 1.5% (P < 0.001). No hypoglycemic events <70 mg/dL or <54 mg/dL were documented in the intraoperative and immediate postoperative periods. No severe adverse events related to device use were recorded.

During the perioperative period, continuing insulin infusion using AHCL system is feasible, maintaining high levels of %TIR and %TINR, without hypoglycemia or serious adverse events. Randomized clinical trials are needed to compare the use of this technology with usual care.