{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T23:14:10Z","timestamp":1785539650139,"version":"3.56.0"},"reference-count":7,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T00:00:00Z","timestamp":1619654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>The goal in type 1 diabetes (T1D) therapy is to maintain optimal glycemic control under any circumstance. Diabetes technology is in continuous development to achieve this goal. The most advanced Food and Drug Administration- and European Medicines Agency-approved devices are hybrid closed-loop (HCL) systems, which deliver insulin subcutaneously in response to glucose levels according to an automated algorithm. T1D is frequently encountered in the perioperative period. The latest international guidelines for the management of children with diabetes undergoing surgery include specific adjustments to the patient's insulin therapy, hourly blood glucose monitoring, and intravenous (IV) insulin infusion. However, these guidelines were published while the HCL systems were still marginal. We present a case of a 9-year-old boy with long-standing T1D, under HCL system therapy for the last 9 months, and needing surgery for an appendectomy. We agreed with the family, the surgical team, and the anesthesiologists to continue HCL insulin infusion, without further adjustments, hourly blood glucose checks or IV insulin, while monitoring closely. The HCL system was able to keep glycemia within range for the total duration of the overnight fast, the surgery, and the initial recovery, without any external intervention or correction bolus. This is, to the best of our knowledge, the first reported pediatric case to undergo major surgery using a HCL system, and the results were absolutely satisfactory for the patient, his family, and the medical team. We believe that technology is ripe enough to advocate for a \u201ctake your pump to surgery\u201d message, minimizing the impact and our interventions. The medical team may discuss this possibility with the family and patients.<\/jats:p>","DOI":"10.3389\/fped.2021.625390","type":"journal-article","created":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T06:18:13Z","timestamp":1619677093000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Hybrid Closed-Loop System Achieves Optimal Perioperative Glycemia in a Boy With Type 1 Diabetes: A Case Report"],"prefix":"10.3389","volume":"9","author":[{"given":"Jesus","family":"Dominguez-Riscart","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Buero-Fernandez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Garcia-Zarzuela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando A.","family":"Marmolejo-Franco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana C.","family":"Perez-Guerrero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso M.","family":"Lechuga-Sancho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,4,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1111\/pan.13708","article-title":"Use of continuous subcutaneous insulin infusion (CSII) therapy in pediatric diabetes patients in the perioperative period","volume":"29","author":"Vanderhoek","year":"2019","journal-title":"Pediatr Anesth."},{"key":"B2","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1111\/pedi.12733","article-title":"ISPAD Clinical Practice Consensus Guidelines 2018: management of children and adolescents with diabetes requiring surgery","volume":"19","author":"Jefferies","year":"2018","journal-title":"Pediatr Diabetes."},{"key":"B3","doi-asserted-by":"publisher","first-page":"94","DOI":"10.2337\/cd18-0067","article-title":"Medtronic MiniMed 670G hybrid closed-loop system","volume":"37","author":"Knebel","year":"2019","journal-title":"Clin Diabetes."},{"key":"B4","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1089\/dia.2019.0400","article-title":"Prospective analysis of the impact of commercialised hybrid closed-loop system on glycaemic control, glycaemic variability and patient-related outcomes in children and adults: a focus on superiority over predictive low glucose suspend technology","volume":"22","author":"Beato-V\u00edbora","year":"2020","journal-title":"Diabetes Technol Ther."},{"key":"B5","doi-asserted-by":"publisher","first-page":"772","DOI":"10.1089\/dia.2016.0288","article-title":"Glycemia, treatment satisfaction, cognition, and sleep quality in adults and adolescents with type 1 diabetes when using a closed-loop system overnight versus sensor-augmented pump with low-glucose suspend function: a randomized crossover study","volume":"18","author":"Sharifi","year":"2016","journal-title":"Diabetes Technol Ther."},{"key":"B6","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1053\/jpsu.2002.32893","article-title":"Pediatric appendicitis score","volume":"37","author":"Samuel","year":"2002","journal-title":"J Pediatr Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1177\/1932296818784068","article-title":"Perioperative use of a hybrid closed loop system in an obese patient with type 1 diabetes undergoing metabolic surgery: insights into changes in insulin delivery and sensitivity","volume":"12","author":"Rodriguez-Diaz","year":"2018","journal-title":"J Diabetes Sci Technol."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.625390\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T06:18:15Z","timestamp":1619677095000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.625390\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,29]]},"references-count":7,"alternative-id":["10.3389\/fped.2021.625390"],"URL":"https:\/\/doi.org\/10.3389\/fped.2021.625390","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,29]]},"article-number":"625390"}}