Advanced hybrid closed-loop therapy in an older adult with 55-year type 1 diabetes: a CARE-based case report

This case describes a 66-year-old man with long-standing type 1 diabetes (diagnosed in 1969) complicated by polyneuropathy, autonomic neuropathy with hypoglycemia unawareness, and advanced diabetic retinopathy. Despite many years of treatment and consistent self-management, he experienced substantial glycemic variability, chronic hyperglycemia (HbA1c 9.2%), and a pronounced fear of hypoglycemia that led to insulin underdosing and maladaptive coping behaviors. Following admission to the Diabetes Clinic of the University Hospital in Krakow, structured diabetes education and psychological support were provided. The patient was subsequently enrolled in a research program and transitioned to the MiniMed™ 780G Advanced Hybrid Closed Loop (AHCL) system, which automatically adjusts insulin delivery based on continuous glucose monitoring. After nine months of AHCL use, the patient showed clinically meaningful improvement in CGM-derived metabolic outcomes (mean glucose 128 mg/dL, GMI 6.4%, TIR 91%, TBR 1%), with no episodes of severe hypoglycemia reported during follow-up. Standardized psychological assessment showed improvement in well-being and reductions in diabetes-related distress and depressive symptoms: WHO-5 increased from 9 to 14, DDS global score decreased from 3.2 to 1.8, PHQ-9 decreased from 7 to 3, and PAID global score decreased from 42 to 35. This CARE-based case report illustrates that AHCL therapy, when implemented together with structured education and psychological support, may be associated with improved glycemic outcomes and reduced psychological burden in selected older adults with long-standing type 1 diabetes. The findings should be interpreted cautiously because they derive from a single case.