{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T13:57:20Z","timestamp":1777557440545,"version":"3.51.4"},"reference-count":38,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:00:00Z","timestamp":1760745600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:00:00Z","timestamp":1760745600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Diabetes Sci Technol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>Hybrid closed-loop (HCL) systems have transformed outpatient diabetes management, yet their application in complex inpatient and hospital-based scenarios remains underexplored. This article examines the utilization of HCL systems in three challenging clinical contexts: the perioperative period, dialysis (hemodialysis and peritoneal dialysis), and during glucocorticoid therapy. Our article and case series examples provide an overview of the current available literature, preliminary data, and practical guidance for clinicians on HCL systems in these settings. Further research is urgently needed to establish the evidence base in this high-risk cohort.<\/jats:p>","DOI":"10.1177\/19322968251381282","type":"journal-article","created":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T02:26:59Z","timestamp":1760840819000},"page":"268-277","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Managing Hybrid Closed-Loop Insulin Delivery in Complex Clinical Scenarios: Focus on Perioperative, Dialysis, and Glucocorticoid Use"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9047-3589","authenticated-orcid":false,"given":"Parizad","family":"Avari","sequence":"first","affiliation":[{"name":"Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK"},{"name":"Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Manchester Royal Infirmary, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9602-1962","authenticated-orcid":false,"given":"Lalantha","family":"Leelarathna","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK"},{"name":"Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6076-6997","authenticated-orcid":false,"given":"Hood","family":"Thabit","sequence":"additional","affiliation":[{"name":"Diabetes, Endocrinology and Metabolism Centre, Manchester Royal Infirmary, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,10,18]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1089\/DIA.2022.0421"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.2337\/dci18-0002"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgac277"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.4103\/jod.jod_4_17"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/dme.14573"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/1932296821993169"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/1932296817706151"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2016-2534"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.4158\/EP161392.CS"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/19322968231191104"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc22-0716"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/19322968221137335"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.3390\/HEALTHCARE11040587"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/PAN.14732"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.2337\/DC22-0438"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/DME.15452"},{"key":"e_1_3_3_18_2","unstructured":"Centre for Perioperative Care. 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