Endocrine Abstracts

Introduction: The assessment of the glycemic regulation of patients with Type 1 Diabetes Mellitus is necessary, in order to design an individualized treatment plan, to control the complications resulting from hyper- or hypoglycemia. For this purpose, we use HbA1c, continuous glucose monitoring (CGM) with TIR (time in range), or blood glucose monitoring (BGM). However, none of the above, can be applied without the cooperation of the patient, which for various reasons, often becomes ineffective.

Case Presentation: We describe 4 cases of patients, who were implanted with a hybrid closed loop subcutaneous insulin pump system. The main problem was their unmanageable condition, resulting in many hospitalizations and poor glycemic control. Patient 1: 24 year old male with type 1 diabetes since the age of 7. HbA1C 10.3% Mental immaturity and learning disabilities. Frequent hospitalizations for DKA (at least 3 per 6 months). He did not take glucose measurements or administer insulin when he was with his friends because of embarrassment. Patient 2: 34 year old male with T1DM since the age of 14. HbA1c 14.4%. Middle school teacher. Many hospitalizations for DKA. He had a phobia of hypoglycemia, so he consciously aimed for glucose values >200. Concomitant medical conditions: Sensorimotor neuropathy and diabetic retinopathy. Patient 3. 32 year old male with type 1 diabetes since the age of 8. HbA1c 11.4%. He did not measure his blood sugar, neither he knew how to calculate carbohydrates. He is a professional driver for a courier company, and he eats irregular meals with many carbohydrates without preprandial insulin. Patient 4: 37 year old male with type 1 diabetes since the age of 9. HbA1c 10.2%. Sometimes anxious and depressed behavior. Cleaning worker on a garbage truck, almost impossible to take measurements or eat while working. Frequent hospitalizations with severe hypoglycemic episodes. Concomitant medical conditions: Arterial hypertension, hypertensive retinopathy, dyslipidemia.

Conclusion: The immediate result of the insulin pump placement, was the stability of glucose values and the avoidance of hospitalizations in all patients. Some of them managed TIR >45% within the first 3 months, without hypoglycemia. The placement of a hybrid closed loop system of subcutaneous insulin infusion, dramatically improved both their glycemic control and much more the general management of diabetes mellitus.