Implementation of a Hybrid Closed-Loop Automated Insulin Delivery System in a 29-Day Infant With Neonatal Diabetes

Neonatal diabetes mellitus (NDM) often requires insulin treatment to maintain adequate glycemic control and support growth and development. Conventional insulin treatment regimens are particularly challenging in NDM due to young age, developmentally appropriate feeding variation, and heightened insulin sensitivity leading to very small insulin dosing. We present this case as-to our knowledge-the earliest implementation of a hybrid closed-loop (HCLS) automated insulin delivery system in an NDM patient. HCLS with U10 significantly improved glycemic control compared to conventional insulin delivery with minimization of hypoglycemia. The adaptive capabilities of HCLS allowed for developmentally appropriate, ad libitum feeding without carbohydrate quantification, resulting in a meaningful quality of life improvement. This case adds to evidence supporting safe and effective use of diabetes technology in very young children. It demonstrates that the benefits seen in older populations can be achieved in neonatal patients and supports expanding clinical use of HCLS systems in this setting.