Transformative Impact of an Advanced Hybrid Closed-Loop System on the Management of Diabetes with Gastroparesis

Gastroparesis, a form of autonomic neuropathy, causes delayed gastric emptying and unpredictable postprandial glycemic fluctuations, increasing hypoglycemia risk due to mismatched insulin timing. We demonstrate the effective application of sensor-augmented pump (SAP) therapy using an advanced hybrid closed-loop (AHCL) system (MiniMed 780G) in an individual with type 2 diabetes complicated by gastroparesis. To assess the adaptability of the AHCL algorithm, we conducted meal tests using two distinct macronutrient compositions—high carbohydrate (bread) and high fat (curry with rice)—and demonstrated that the AHCL system appropriately responded to complex postprandial glycemic fluctuations. The system autonomously adjusted basal rates and delivered correction boluses in response to delayed glucose rises, markedly reducing hypoglycemia. The patient achieved excellent glycemic management, with time in range (70–180 mg/dL) of 88% and time below range (<70 mg/dL) of <1%. AHCL-based SAP therapy may be especially beneficial in gastroparesis-associated glycemic variability.