February 28, 2025

Leads:

Carol Levy – Mt. Sinai (Adult)

Emily Coppedge – Cornell (Peds)

Updates:

The group aims to facilitate discussions on utilizing hybrid closed loop systems in diverse populations, including off-label and high-risk cases.
The group encourages members to share expertise, start QI projects based on discussions, and allow speakers to be contacted for further questions.
A past discussion focused on diabetes, hyper closed loop, and pregnancy.
Recent email exchange covered managing patients in ketoacidosis using aid systems.
Acknowledgment that much of the discussion involves off-label use and isn’t always evidence-based, but rather sharing clinical ideas.

Dr. Erin Cobrey (BDC Peds) Discussed Inpatient Pediatric Diabetes Technology Use

Discussion on key takeaways, research findings, and implications for clinical practice
Q&A with Dr. Levy

Discussion on Device Use Hospital Policies:

Adult side has policies for insulin pump use, including patient contracts and finger stick testing requirements. Haven’t yet ventured into specific policies for aid use.
Allowing aid use during surgery, as anesthesiologists are generally accepting.
Concerns and lack of data from the institution can cause hesitation.
Labor and delivery pose challenges regarding insulin management (pharmacy vs. patient-supplied).

Current Practices and Challenges:

Endocrine is consulted for pump-related issues, but practices vary across institutions. Outpatient procedures generally allow patients to keep pumps and CGMs on, with some anesthesiologists preferring it.

Inpatient management of pumps and CGMs is inconsistent; nurses are required to do finger sticks even with CGM use. There’s a lack of awareness among medical staff about automated insulin delivery (AID) systems.

Approving AID Systems:

Suggestion to extend pump approval to include AID systems. Nursing communication emphasizes CGM use for monitoring, not treatment adjustments.
Template non-formulary orders include insulin pump settings for parent administration. One case showed Omnipod 5 effectively managing blood sugars for a CF patient.

The Group Discussed Topics for Hybrid Closed Loop Systems

Education and Training
DIY Systems and Community Innovation
Carb Counting and Hybrid Closed Loop Systems
Severe Insulin Resistance
AID for Very Young Children
AID for the Elderly
AID for People Who Learn Differently
Off-label Use of Adjunctive Therapies with HCL
Sick Day Management
Ketone Management

Next Steps:

Members are encouraged to share hospital policies or summaries via email. Suggestion to create a list of essential policy components for hospitals.
Future topics include/ older adults and hybrid closed loop (Dr. Weinstock to present in April) and DIY systems (possibly Rayon Mahal). Emily Coppedge also volunteered to share in March
Long-acting insulin with hybrid closed loop is another potential topic.
Next meeting: Friday March 28, 2025.

Cincinnati Children’s has an inpatient CGM policy: Cincinnati Children’s has an inpatient CGM policy

Dr. Cobrey’s Presentation: Dr. Erin Cobry Technologies in the Hospital Presentation

Meeting Recording: Hybrid Closed Loop Working Group-20250228_140226-Meeting Recording.mp4