Use of Automated Insulin Delivery Systems Following Pediatric Total Pancreatectomy and Islet Auto Transplantation

Total pancreatectomy with islet auto-transplantation (TPIAT) treats intractable pain in patients with pancreatitis. Automated insulin delivery (AID) systems improve glycemic control in patients with diabetes, but their role in post-TPIAT glycemic management needs exploration. This case series included two patients who initiated AID after TPIAT at the Johns Hopkins Children's Center from August 2024 to June 2025. Following TPIAT, a 10-year-old male using AID met the glycemic target of 80-130 mg/dL with a mean blood glucose of 119 ± 23 mg/dL, time in range of 71%, time above range of 28%, and time below range of 1%. Similarly, in a 16-year-old female using AID after TPIAT mean blood glucose was 106 ± 15 mg/dL, time in range was 81%, time above range was 17%, and time below range was 2%. AID use after TPIAT can maintain tight glycemic control without hypoglycemia or hyperglycemia and may be considered for use in post-TPIAT glycemic management.