Early use of Hybrid Closed-loop following Total Pancreaticoduodenectomy.

Abstract

Diabetes secondary to total pancreaticoduodenectomy (TP) is challenging to manage due to high glycemic variability and risk of hypoglycemia, in a frail population. We report the case of four patients with no prior diabetes who underwent TP. Three of four patients needed artificial nutritional support. Hybrid closed-loop (HCL) insulin therapy was initiated within 12 weeks of surgery. After 90 days of HCL treatment, continuous glucose measurement showed a 70.4 ± 11.8% time in range (versus 43 ± 6.5% before HCL); 0.2 ± 0.2% time below range (versus 0.6 ± 0.5% before HCL); 23.8 ± 9.1% time above range 180-250 mg/dl (versus 22.9 ± 6.1% before HCL); 4.2 ± 2.5% time above range > 250 mg/dl (versus 33.8 ± 3.9% before HCL). The glucose management indicator improved from 8.5 ± 0.6% to 6.9 ± 0.6%. There was no severe hypoglycemia or need for unplanned medical attention. Early post-operative use of HCL allowed our patients to achieve safely optimal glycemic control after TP.