Use of hybrid closed-loop insulin pump in pancreatogenic diabetes following necrotizing hemorrhagic pancreatitis: a case report

Pancreatogenic diabetes is a frequent and often underestimated consequence of acute and chronic pancreatitis. This form of diabetes shows clinical characteristics intermediate between type 2 and type 1 diabetes, presenting both insulin resistance and an insulin secretory defect that often requires earlier initiation of insulin therapy. We describe the case of a 60-year-old man with a history of obesity and family predisposition to diabetes who developed diabetes after necrotizing hemorrhagic acute pancreatitis complicated by portal vein thrombosis. The patient expressed great concern about his persistent hyperglycemia and marked glucose variability. Despite intensive treatment with oral antihyperglycemic agents and a basal-bolus insulin regimen, glycemic control remained suboptimal and characterized by wide fluctuations. Given the very high basal-to-bolus insulin ratio and the need for dynamic insulin delivery, the mylife Loop insulin delivery system was initiated. This resulted in a rapid and sustained improvement of glycemic control, with the Time in Range (TIR) increasing from 43% to 72% after one month and up to 88% at three months, while the Glucose Management Indicator (GMI) decreased from 7.9% to 6.5%. Benefits were stable at six months. To our knowledge, this is the first report describing the use of hybrid closed-loop insulin delivery system in diabetes following pancreatitis, and highlights how this technology can be particularly useful in achieving optimal glycemic control in patients in whom oral therapy is insufficient and conventional basal-bolus regimens are limited by the inability to personalize insulin delivery throughout the day. Automated insulin delivery proved effective in addressing the peculiar challenges of pancreatogenic diabetes, including high glycemic variability and a more complex management of prandial insulin therapy.