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

Area of Science:

• Endocrinology
• Medical Devices
• Surgical Care

Background:

• Limited evidence exists on advanced hybrid closed-loop (AHCL) systems' safety and efficacy in the perioperative period.
• There's a lack of specific management guidelines for AHCL systems during surgical procedures.

Purpose of the Study:

• To evaluate glycemic control metrics in patients using AHCL systems during intraoperative and postoperative phases.
• To assess the safety and feasibility of AHCL systems in surgical patients with diabetes.

Main Methods:

• Prospective cohort study of adult patients with type 1 or type 2 diabetes using the MiniMed™780G AHCL system during surgery.
• Comparison of time in range (TIR), time below range (TBR), time above range (TAR), and time in normoglycemia range (TINR) during perioperative periods versus baseline.

Main Results:

• AHCL systems maintained high time in range (99.6%) and time in normoglycemia (58.6%) during surgery.
• Significant reduction in time below range (<70 mg/dL) to 0% and time above range (>180 mg/dL) to 0.1% was observed.
• No hypoglycemic events (<70 mg/dL or <54 mg/dL) or severe device-related adverse events occurred.

Conclusions:

• Continuing AHCL system insulin infusion is feasible and safe during the perioperative period.
• AHCL systems effectively maintain glycemic control, achieving high TIR and TINR without hypoglycemia.
• Randomized clinical trials are recommended to compare AHCL technology with standard perioperative diabetes management.