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Hybrid Closed-Loop Pump — RACP Adult Medicine MCQ

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ModerateEndocrinologyHybrid Closed-Loop PumpRACP Adult Medicine

A 25-year-old woman with type 1 diabetes on insulin pump has recurrent severe hypoglycaemia (3 episodes requiring third-party assistance in 6 months) with hypoglycaemia unawareness. HbA1c is 53 mmol/mol. She has impaired awareness of hypoglycaemia (Gold score 5). CGM shows frequent glucose <3.0 mmol/L. What is the most appropriate technology intervention?

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Correct answer: D — Upgrade to hybrid closed-loop insulin pump system

Recurrent severe hypoglycaemia with impaired hypoglycaemia awareness in T1DM — hybrid closed-loop (HCL) systems (e.g., Medtronic 780G, Tandem Control-IQ, Omnipod 5) automate insulin delivery based on CGM glucose readings, significantly reducing time below range (<3.9 mmol/L) and severe hypoglycaemia while improving time in range (3.9-10.0 mmol/L). HCL reduces HbA1c AND hypoglycaemia simultaneously (unlike conventional pump therapy where tighter control increases hypo risk). PBS-listed in Australia for eligible patients.

Reference: ADS – 2024 – Insulin Pump Technology; NICE 2024 T1DM