Taka Hidetsugu, Sugai Keiji, Shikuma Jumpei, Suzuki Ryo
Department of Diabetes, Metabolism and Endocrinology, Tokyo Medical University, Tokyo, Japan.
Front Endocrinol (Lausanne). 2025 Jul 31;16:1611540. doi: 10.3389/fendo.2025.1611540. eCollection 2025.
Recent advances in automated insulin delivery (AID) system have been remarkable. The advanced hybrid closed-loop (AHCL) system made it easier to achieve optimal glycemic targets. According to previous studies, the AHCL system achieves relatively good glycemic control without strict carbohydrate input. These studies suggested that AID systems potentially improve glycemic control among patients with difficulty with self-management. However, few studies have focused on the efficacy of the systems among these patients. We present a case of a 30-year-old woman with type 1 diabetes and intellectual disabilities (full-scale intelligence quotient = 67) due to Shwachman-Diamond syndrome. While using a sensor-augmented pump with the predictive low glucose suspend system, her glycated hemoglobin levels consistently ranged from 9.0% to 10.0%, and she experienced frequent hospitalizations due to diabetic ketoacidosis. Stepping up to a hybrid closed-loop system achieved better glycemic control and prevented hospitalizations due to diabetic ketoacidosis. Finally, the patient achieved optimal glycemic control through the use of the AHCL system. Our case highlights the potential of AID systems in patients with type 1 diabetes and self-management difficulties, including those with intellectual disabilities.
自动胰岛素输送（AID）系统最近取得了显著进展。先进的混合闭环（AHCL）系统使实现最佳血糖目标变得更加容易。根据先前的研究，AHCL系统在无需严格碳水化合物摄入的情况下就能实现相对良好的血糖控制。这些研究表明，AID系统有可能改善自我管理困难患者的血糖控制。然而，很少有研究关注这些患者中该系统的疗效。我们报告一例30岁1型糖尿病女性患者，因施瓦赫曼-戴蒙德综合征伴有智力障碍（全量表智商=67）。在使用带有预测性低血糖暂停系统的传感器增强型泵时，她的糖化血红蛋白水平始终在9.0%至10.0%之间，并且因糖尿病酮症酸中毒频繁住院。升级到混合闭环系统后实现了更好的血糖控制，并预防了因糖尿病酮症酸中毒导致的住院。最后，患者通过使用AHCL系统实现了最佳血糖控制。我们的病例突出了AID系统在1型糖尿病及自我管理困难患者（包括智力障碍患者）中的潜力。
