Advanced hybrid closed-loop system: first successful clinical case after total pancreatectomy

A 64-year-old woman has undergone in February 2019 total spleen-preserving pancreatectomy for cystic pancreatic neoplasia. In her medical history, in 2010 she also underwent total thyroidectomy because of thyroid cancer. She is a former smoker who quitted smoking in 2014. From February 2019, she assumes pancrelipase 10.000 UI daily as pancreatic replacement therapy and from 2010 levotiroxine for thyroid replacement. At the discharge, insulin therapy with multiple daily injections, supported by advanced educational therapeutic plan about carbohydrates counting, was started, but, after a severe hypoglycemic event, she developed an important fear of hypoglycemia with a consequent wrong approach to the insulin therapy, preferring to maintain glycemic values higher than 200 mg/dL in order to avoid hypoglycemia. Insulin therapy with continuous subcutaneous insulin infusion (CSII) was suggested, but she refused mainly because of discomfort. Yearly mean glycated hemoglobin (HbA1c) was 74 mmol/mol (8.9%). In December 2019, she was admitted to emergency room because of another severe hypoglycemia with loss of consciousness due to inappropriate insulin administration. After this event, patient started real-time continuous glucose monitoring (CGM—Medtronic Guardian Connect, Northridge California).