12550 Unconventional Therapy For A Patient With Latent Autoimmune Diabetes In Adults (lada), Morbid Obesity And Disease Burden: The Use Of Insulin Lispro U- 200 Automated Insulin Delivery (aid) System
Authors: Campana Mario S , Zelada Henry 
Published: October 2024

Abstract
Disclosure: M.S. Campana: None.
Introduction: Patients with Type 1 Diabetes Mellitus (T1DM) or LADA with obesity have been seen more often in our daily practice over the last few years. Although the pharmacokinetics and pharmacodynamics of Insulin Lispro U-200 are similar to U-100, the use of concentrated insulin delivery via an Automatic Insulin Delivery (AID) system is not approved by the FDA at the moment. Therefore, we report the use of the Insulin Lispro U-200 AID system (Ominpod-5) as a treatment modality for a patient with LADA, obesity, uncontrolled diabetes, and the burden of the disease due to daily insulin pump pods change. Description of the case: A 48-year-old woman with a history of hyperlipidemia, hypertension, and diabetes mellitus since she was 26-year-old. She was started on metformin 500 mg twice a day and glipizide 5 mg daily. She sought a second opinion on diabetes management at our diabetes clinic, where her diabetes was classified as LADA. She was switched to multiple daily insulin injections (MDI) and then started on Lispro U-100 Medtronic insulin pump delivery system 670 G with Guardian-2 as continuous glucose monitoring (CGM). During her 3-month follow-up, her A1C was 8.7%, and CGM parameters were, TIR (Time-in Range, BG 70-180 mg/dL) of 48%, TAB (time above range, high 180-250, very high &gt;250), of 36%, and 16%, TBR (time bellow range, glucose &lt;70%) of 0%, and GMI (glucose management indicator) of 8.4%. She was subsequently switched to Lispro U-100 Omnipod-5 AID with minimal improvement in her diabetes, with an A1C of 8.4%, TIR 50%, high 38%, very high 12%, low 0%, and GMI of 8.1%. She required a high amount of insulin and needed to change her insulin pump pods every day which interfered with her daily life and was unable to afford it. After these barriers, we switched her to U-200 Omnipod-5 AID to decrease her disease burden and adjusted her insulin pump setting accordingly. During her 3-month follow-up visit after starting on U-200 AID, her CMG parameters improved to GMI of 7.1%, TIR 69%, high 26%, very high 3%, and &lt;1% lows. She was able to change her insulin pump pods from every day to every other day. Her CGM parameters after 6 months improved to GMI of 7.1%, TIR 78%, high 18%, very high 3%, and low 1%. A year later they remained at goal with a GMI 7.1 %, TIR 78%, High 19%, very high 2%, and low &lt;1%. Discussion: The use of the Insulin Lispro U-200 AID system has not been adequately studied in patients with LADA, obesity, and high insulin requirements. Despite that U-200 insulin pump delivery system is not FDA approved at the moment for patients with T1D or LADA, we are reporting a sustained improvement in TIR, TAB, TBR, and GMI persisted up to a year after initiating Lispro U-200 AID. Additionally, we observed a decrease in the frequency of insulin pump pod changes and an improvement in the disease burden of our patients. Further studies of the U-200 insulin pump should be considered in patient with T1D, LADA, obesity and disease burden should be considered.
Presentation: 6/1/2024