SUN-538 - Management of Type 1 Diabetes with Ilet While Receiving Peritoneal Dialysis

Introduction: Glycemic management in patients with diabetes complicated by kidney failure (KF) undergoing peritoneal dialysis (PD) presents unique challenges. Altered insulin clearance, glucose absorption from peritoneal dialysate and fluctuating metabolic demands contribute to heightened glycemic variability in this population. To date, only one study has reported successful use of automated insulin delivery (AID) system (Medtronic MiniMed 670g) in a patient with type 1 diabetes (T1D) and kidney failure on PD. We report the first case of successful glycemic management using the iLet insulin pump following initiation of PD.

Clinical case: A 52-year-old man with a history of T1D complicated by gastroparesis and advanced chronic kidney disease presented for consideration of AID for improved glycemic management. The patient had a longstanding history of diabetes since his 20s with suboptimal glycemic control. Between 2024 and 2025, he required three hospitalizations for DKA and one hospitalization for severe hyperglycemia. During this interval he was receiving an outpatient insulin regimen composed of glargine 14-16 units once daily, aspart insulin 5-7 units per meal, and a correctional scale. His A1c ranged from 7.8% to 13.7%. He wore a Dexcom G7 continuous glucose monitor and his 30-day time in range (TIR) fluctuated between 24% and 60%. In September 2025 he was fully initiated on Beta Bionics’ iLet insulin pump. Subsequently, he initiated continuous ambulatory PD with a schedule of four daily manual exchanges (6am, 11am, 4pm, 7pm), each using two liters peritoneal dialysate containing a dextrose concentration of 1.5% providing a total carbohydrate load of 120 grams. He was instructed not to enter PD exchanges as meal announcements in the iLet system and to avoid administering additional subcutaneous insulin. His A1c improved to 5.7% in September. Notably, his TIR also improved compared to MDI. His TIR was 83% in September, 76% in October, 60% in November, and 76% in December. Data from December showed an average glucose of 141 mg/dL and standard deviation of 53 mg/dL with a GMI of 6.7%. Hyperglycemia occurred postprandially, and his nighttime blood glucose remained consistently within goal. Total daily dose of insulin was about 27 units. He has not required additional hospitalizations thus far.

Conclusion/Teaching Points: Our case is the first to describe the glycemic effects of an iLet insulin pump in a patient with type 1 diabetes and KF on PD. Over the course of four months, we observed significant improvements in TIR, average glucose, and GMI. Though glycemic control is typically challenging while initiating PD due to fluid shifts and dextrose-based dialysate, here we have eliminated the need for manual insulin adjustments by allowing the iLet pump to operate autonomously. In conclusion, utilization of an AID system can be safe and appropriate for patients with diabetes and KF receiving PD.

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