Namasivayam Abirami, Walton-Betancourth Sandra, Hysted Helen, Datta Vipan, Myles Cliodhna, Boughton Charlotte, Marcovecchio M Loredana, Thankamony Ajay
Department of Paediatric Diabetes and Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Department of Paediatrics, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
Ann Pediatr Endocrinol Metab. 2025 Jun;30(3):157-162. doi: 10.6065/apem.2448150.075. Epub 2025 Jun 30.
Variable rate intravenous insulin infusion (VRIII) is often administered to hospitalized patients with diabetes, who are unwell and have complex nutritional needs. However, VRIII is a reactive approach to insulin delivery that is not based on physiology, is associated with significant safety concerns, and is extremely resource intensive. Fully closed-loop (FCL) systems are promising technologies in diabetes management. CamAPS HX is one of these systems that improves glycemic outcomes in adults, but evidence of its effectiveness and safety in children is lacking. In this report, we present a case of a 14-year-old adolescent who developed diabetes secondary to acute necrotizing pancreatitis and was associated with complications that included esophageal perforation and peripancreatic collections. He was initially treated with VRII to manage total parenteral nutrition (TPN) before transitioning to nasogastric tube feeding. However, variable tolerance to nasogastric feeds and frequent titration of TPN posed significant challenges to insulin therapy. Therefore, the CamAPS HX FCL system was initiated which allowed maintenance of stable glucose levels without hypoglycemia during the gradual transition from TPN to enteral nutrition. This case provides evidence that use of FCL systems is safe and effective for management of inpatient children and adolescents with diabetes and complex nutritional needs. To our knowledge, this is the first reported case of a pediatric inpatient in whom diabetes was managed using an FCL system.
可变速率静脉胰岛素输注（VRIII）常用于患有糖尿病且身体不适、营养需求复杂的住院患者。然而，VRIII是一种基于非生理状态的胰岛素给药反应性方法，存在重大安全隐患，且资源消耗极大。全闭环（FCL）系统是糖尿病管理中很有前景的技术。CamAPS HX是其中一种能改善成人血糖结果的系统，但缺乏其在儿童中有效性和安全性的证据。在本报告中，我们介绍了一名14岁青少年的病例，该患者因急性坏死性胰腺炎继发糖尿病，并伴有包括食管穿孔和胰周积液在内的并发症。他最初接受VRII治疗以管理全胃肠外营养（TPN），之后过渡到鼻胃管喂养。然而，对鼻胃管喂养的耐受性变化以及TPN的频繁调整给胰岛素治疗带来了重大挑战。因此，启动了CamAPS HX FCL系统，该系统在从TPN逐渐过渡到肠内营养期间能够维持稳定的血糖水平且无低血糖发生。该病例证明，FCL系统用于管理患有糖尿病且营养需求复杂的住院儿童和青少年是安全有效的。据我们所知，这是首例报道使用FCL系统管理糖尿病的儿科住院患者。
