Use of automated insulin delivery during major surgery in patients with type 1 diabetes: Two case reports

With the rapid advancement of diabetes technology, the number of patients with type 1 diabetes (T1D) using automated insulin delivery (AID) systems is increasing, making the presence of such patients in the perioperative period more common. This study presents two cases of T1D patients who underwent thyroidectomy while using AID, following a protocol designed in collaboration with the diabetology, anesthesiology, and surgical teams. Two female patients, aged 12 and 33 years, both using AID systems, were admitted for elective thyroidectomy. Glycemic metrics prior to surgery indicated good glycemic control, leading to the decision to continue AID during the procedures. The use of AID enabled safe surgical performance with satisfactory glycemic control. In one case, a continuous glucose monitoring (CGM) sensor disruption likely resulted from acetaminophen distribution and/or sensor's proximity to the surgical field. This report highlights the need for standardized guidelines regarding the use of AID in the perioperative period.