Closed-loop insulin delivery in end-of-life care: a case report.

Boughton, C K; Bally, Lia; Hartnell, S; Wilinska, M; Coll, A P; Evans, M; Stettler, Christoph; Hovorka, R (2019). Closed-loop insulin delivery in end-of-life care: a case report. Diabetic medicine, 36(12), pp. 1711-1714. Wiley 10.1111/dme.13974

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BACKGROUND

Glucose management for people with diabetes approaching the end of life can be very challenging. The aim is to balance a minimally invasive approach with avoidance of symptomatic hypo- and hyperglycaemia.

CASE REPORT

We present a case of a hospitalized individual whose glucose was managed with closed-loop insulin delivery within a randomized controlled trial setting during a period of terminal illness. During the time in which closed-loop insulin delivery was used, glucose control was safe, with no glucose-related harm. The mean ± sd sensor glucose for this individual was 11.3 ± 4.3 mmol/l, percentage of time spent in target glucose range between 6 and 15 mmol/l was 70.5%, time spent in hypoglycaemia was 2.0% and time spent in significant hyperglycaemia >20 mmol/l was 2.6%.

CONCLUSION

Closed-loop systems can accommodate personalized glucose targets and highly variable insulin requirements. Factory-calibrated continuous glucose sensors and insulin pump therapy are less intrusive than finger-stick glucose measurements and insulin injections, respectively. Closed-loop systems may provide a safer and less burdensome approach to glucose management towards the end of life.

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