**2.1 Case report Anna**

**Focus**: 30 years lasting management of T1D using various insulin pumps, and eventually improved quality of life along with a subtle reduction in HbA1c after the sensor-augmented insulin pump, MiniMed 780G, was implemented.

**History:** At 9 years of age (1975), Anna (today 57 y/o) was admitted to the emergency department for a hyperglycaemic coma. Based on history, clinical, and laboratory findings, T1D was diagnosed. From 1975 to 1983, treatment was done with animal insulin consisting of insulin delivery by a glass syringe and a blunt metal needle. At that time self-monitoring was not available apart from a urinalysis. Anna's description of her medical care from 1983 to 1991 is vague. In 1992, she was referred to a diabetes center and received MADI (manual insulin dispenser) [22]. In 1993, she obtained her first glucometer, which Anna describes as a milestone in her life as a person with T1D. In 1993, she obtained her first insulin pump (Dahedi Elektroniks), which reduced the INS/d day from 34 to 29 IU. Next, the pump Dahedi was replaced by a pump H-Tron V100, Disetronic (1994–2008). In 1996, she became pregnant with twins. Both children (boy and girl) were born on January 10, 1997, healthy, by planned Cesarean section (indicated by a breech position of one of the children) with body mass at births of 2.6 and 2.7 kg. In the following period of 25 years, Anna's clinical condition was stable. She performed intensive selfmonitoring (SMPG) using glucometerstrips system 5 to 12 times a day and adopted the insulin boluses according to plasma glucose, food, and exercise. In 2009 insulin pump Paradigm 722 was implemented, followed by Paradigm Veo 554. In 2010, hypothyroidism was diagnosed and treated further on.

In 2021, the hybrid insulin pump MiniMed 780G was put in motion. Anna has been continuously employing the SmartGuard mode (**Figures 3** and **4**). The important clinical and laboratory findings can be seen in **Table 1**. Current TIR: 89%.


### **Table 1.**

*Anna's clinical and laboratory parameters over 28 years.*

*Benefits of Implementation of Insulin Pump in People with Type 1 Diabetes: 10 Case Reports DOI: http://dx.doi.org/10.5772/intechopen.110073*

## **Figure 3.**

*Anna's absolute values of HbA1c, BM, and INS/d since her first pump D (Dahedi Elektroniks) was implemented. Insulin pump H-tron (1994–2008) was followed by pumps paradigm (without CGM). Since the therapy with a sensor-augmented insulin pump MiniMed 780G with SmartGuard auto mode was applied in 2022, there is a subtle improvement in HbA1c concentration (red box). See also red box in Figure 4.*

### **Figure 4.**

*Anna's relative values of HbA1c, BMI, and INS/d from 1993 to 2022 indicate an extended period of HbA1c at 30% above the norm with slight fluctuation and a 10% decrease within 1 year after CGM implementation. Over the entirety of 29 years, BMI remains stable in the high 80s and low 90s. There is no difference in INS/d before and after MiniMed 780G. D – Dahedi Elektroniks, P – Paradigm, M – MiniMed.*

**Current goal:** To reduce LDL below 2.6 mmol/l and HbA1c below 50 mmol/mol without hypoglycemia, therapy of hypoglycemia with glucagon; screening for macroangiopathy (**Table 1**).
