Case 7: Hybrid closed-loop therapy

Panel B, which displays data from the first (older historical) 14-day period, shows hyperglycemia after lunch and in the late evening. Continuous glucose monitoring (CGM) glucose values are shown in the upper panel for a representative day. The pink lines below represent insulin microdoses. When in the automatic ("Auto") mode, insulin microdoses are given as often as every 5 minutes for basal coverage, using a target glucose of 120 mg/dL (6.7 mmol/L). The purple "drops" show insulin boluses for meals, and the orange squares indicate the carbohydrate content of those meals.
Panel A, which displays data from the most recent 14-day period, shows improvement in post-lunch hyperglycemia after the insulin-to-carbohydrate ratio for lunch was changed, but persistent variability in late afternoon and evening. The time spent in target range (70 to 180 mg/dL [3.9 to 10.0 mmol/L]) improved from 56 to 72%. The blue shaded area shows the interquartile glucose readings (25^th to 75^th percentiles) during this 14-day period, and the blue solid lines show the 0 to 90^th percentile range. The orange shaded area and orange dashed lines show these data for the previous 14-day report period ("B").