Hybrid closed-loop insulin system safely controls blood sugar in a 29-day-old infant with neonatal diabetes
Key takeaway:
A hybrid closed-loop insulin delivery system successfully managed blood glucose in a 29-day-old infant with neonatal diabetes, using diluted U10 insulin to eliminate dangerous hypoglycemia while allowing normal feeding without carb counting.
Study at a glance
What was studied
Hybrid closed-loop system in a 29-day-old with neonatal diabetes
Study type
non-randomized clinical trial (non-RCT or NRCT)
duration
Short-Term (≤3 mo)
Intervention
Hybrid closed-loop system
Outcomes
Time in range, Time below range, Time above range, Glucose variability, Blood glucose, HbA1c
Funding
Non-industry sponsored
Main effects
Hybrid closed-loop system ↑ Time in range from 6.6% to 45.5-56.9% ↓
Diluted U10 insulin eliminated hypoglycemia (0% time below range) ↓
HbA1c reached 4.8% at 2 months post-discharge with minimal hypoglycemia ↓
Evidence Suggest
- HCLS with diluted U10 insulin achieved safe glycemic control in a 29-day-old NDM infant
- Omission of carbohydrate dosing allowed normal ad-libitum feeding without glucose compromise
- Automated insulin delivery eliminated severe hypoglycemia compared to IV/subcutaneous regimen
Who this applies to
This case applies to infants diagnosed with neonatal diabetes mellitus who require insulin treatment, particularly those with transient forms due to chromosome 6q24 abnormalities or other genetic causes requiring insulin therapy.
Keep in Mind
This is a single case report, not a controlled trial. The off-label use of HCLS requires regulatory considerations, specialized caregiver education, and compounded diluted insulin with limited shelf life (28 days). Results may not apply to all NDM subtypes or across all available HCLS platforms.
Between the Lines
- Single case report with no control group (n=1)
- Short observation period (7 days per treatment modality)
- Not generalizable without further study in larger NDM populations
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Journal Reference
Ghaben AL, Byer-Mendoza C, McNamara K, et al. Implementation of a Hybrid Closed-Loop Automated Insulin Delivery System in a 29-Day Infant With Neonatal Diabetes. JCEM Case Rep. 2026;4(3):luaf338. doi:10.1210/jcemcr/luaf338
Sources
Ranked by clinical relevance and evidence quality.
Key References
Most relevant evidence and guidance related to this research.
International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024: Diabetes Technologies - Insulin Delivery
International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024: Diabetes Technologies - Glucose Monitoring
Supporting Evidence
Supporting evidence and related resources.
Best Protein-Rich Foods for Diabetes | American Diabetes Association
Blood Glucose and Exercise: Managing Post-Exercise Hyperglycemia & Glucose Spikes
Blood Glucose Meters Can Play an Important Role in Diabetes Care | American Diabetes Association
Causes and How to Prevent Hypoglycemia (Low Blood Glucose) | American Diabetes Association
Hybrid closed-loop systems and glycemic outcomes in children and adults with type 1 diabetes: real-world evidence from a U.S.-based multicenter collaborative
Neonatal Diabetes Mellitus: an update on diagnosis and management
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