28-year-old with type 1 diabetes and multiple autoimmune diseases — the need for the individualization of diabetes treatment

The aim of this case report is to summarize the clinical picture of a patient with T1DM and other autoimmune diseases, highlighting the individualization of treatment. A 28-year-old patient was diagnosed with T1DM, followed by autoimmune thyroiditis and celiac disease. In the following years, Crohn's disease, primary sclerosing cholangitis, and autoimmune hepatitis were diagnosed. At the same time, primary adrenocortical insufficiency was excluded based on a Synacthen test. The patient has been treated with a personal insulin pump (initially insulin aspart, later insulin lispro) for 15 years. Azathioprine and methylprednisolone were prescribed for Crohn's disease. HbA1c was 8.4% in January 2017. Treatment with a single morning dose of methylprednisolone (8 mg) required a non-physiological basal insulin infusion pattern, peaking at 1.45 units/h between 12:00 and 20:00. Empagliflozin 10 mg once daily was initiated, followed by dapagliflozin 5 mg from 2019. After four weeks, the average glycemia over 14 days was 185 (± 78.3) mg/dl. From January 2023, following reimbursement for glucose monitoring in patients aged 26 and above, the patient began using FreeStyle Libre 2, leading to improved metabolic control. To our knowledge, this is the first description of a patient with T1DM and a wide range of autoimmune disorders in whom metabolic control was improved using a non-standard insulin pump regimen, a continuous glucose monitoring system, and an SGLT-2 inhibitor.