Endocrine Abstracts

Background: The leading cause of visual impairment among individuals with diabetes is diabetic retinopathy. Hybrid closed-loop (HCL) therapy has revolutionised diabetes care, offering a more automated and precise approach to insulin delivery. However, these technologies can inadvertently marginalise individuals with disabilities, including those with visual impairment.

Case: We present the case of a legally blind 70-year-old female with a 60-year history of T1DM and proliferative diabetic retinopathy. Other medical history includes ischemic heart disease, chronic kidney disease with microalbuminuria, hypothyroidism, dyslipidaemia, and hypertension. Since 2003, she has been managed with insulin-pump therapy, and more recently with sensor-augmented pump therapy, using the Medtronic MiniMed Paradigm Veo 754 with Guardian 2 sensor. Due to difficulties with the Guardian 2 application, it was replaced by Dexcom G6. Her baseline HbA1c was 7.5% (58 mmol/mol). She has impaired hypoglycaemia awareness and experienced recurrent hypoglycaemia. Upon pump renewal, she chose the mylife Ypsomed pump with Dexcom G6 and CamAPS FX, as it allowed her to use a visual aid to view a smartphone screen.

Intervention: In-person training was conducted at the Diabetes Day Centre. Although she has limited carbohydrate counting skills, a consultation with the dietitian led to the creation of a meal chart. The bolus advisor was configured with small, medium, and large meal options.

Outcome: Over nine months, she showed significant improvement in glycaemic control: time-in-range increased from 55% to 67% and time-below-range decreased from 10% to <1%. Self-reported hypoglycaemia awareness improved from <2.5 mmol/l to 3.9 mmol/l with a Gold score of 1. She expressed satisfaction with the system, noting significant reduction in the overall burden of managing diabetes.

Conclusion: HCL therapy can enhance glycaemic control and quality of life in visually impaired individuals. This case emphasises the need for individualised diabetes management strategies and the benefits of advanced technologies in complex clinical scenarios.