Endocrine Abstracts

JOINT2741

Hybrid closed loop (HCL) insulin pumps represent a significant advancement in diabetes management and has shown to improve glycaemic outcomes, reduce diabetes-related distress, and improve quality of life. However, its application in residential environments is not well studied. This case study explores the effectiveness of using a HCL insulin pump in a residential setting in a 27-year old woman with Type 1 diabetes (T1D) who is unable to self-care diabetes. She has Trisomy 21, T1D for five years, total hypoglycaemia unawareness, primary hypothyroidism, coeliac disease, and oesophageal achalasia. She lives in residential care and has very limited vocabulary and sensory issues with insulin injections. Oesophageal achalasia deteriorated over the years despite pneumatic dilatations, and only minimal oral food intake became possible. Therefore, percutaneous endoscopic gastrostomy (PEG) tube was inserted to administer the nutrition. Despite being on basal bolus regimen with insulin aspart and detemir and wearing real-time continuous glucose monitoring, her glycaemic ranges were suboptimal (average sensor glucose 14.5mmol/l, GMI 9.6%, Time-in-Range 15%, Very High-Above-Range 57%, High-Above-Range 28%, HbA1c 61mmol/mol). She required multiple hospital admissions due to hyperglycaemic and hypoglycaemic episodes and her quality of life was affected due to recurrent and prolonged hospital admissions. There was also a significant weight gain with BMI 43 kg/m². Considering all above, the diabetes MDT explored the option of Metronic MiniMed^TM 780G HCL insulin pump with the patient’s family and caregivers. Initially, 22 residential staff were trained using a virtual insulin pump platform to familiarize them with pump functions. This was followed by practical, in-person sessions, where staff learned to perform tasks such as set insertions and changes. Smartguard technology was integrated into the training to enhance the staff’s ability to manage glucose levels effectively. The diabetes MDT followed up very closely with the patient and caregivers in-person and virtually to adjust the PEG feeding plan and HCL system. The patient has been on HCL system for the past eight months and glycaemic ranges have improved significantly (average sensor glucose 9.3mmol/l, GMI 7.3%, Time-in-Range 55%-67%, Time-below-Range 0-1%, HbA1c 53mmol/mol). Since HCL system, the patient had only two short hospital admissions, is energetic, participating in daily activities and her weight has reduced by 5 kg. Our case suggests that HCL system together with a skilled diabetes MDT support offers promising benefits for residential use. Continued research is necessary to optimise the functionality of HCL system for this cohort.