Judicious use of modern technology with antihyperglycemic agents: The changing landscape of type 2 diabetes management

Background: Continuous subcutaneous insulin infusion (CSII) pump has shown good outcomes in patients with both type 1 and type 2 diabetes mellitus. Here, we present an individual with type 2 diabetes and obesity who was on a high dosage of insulin and oral hypoglycemic agents (OHA) were able to get diabetes under good control with weight reduction after using a hybrid artificial closed-loop insulin pump system along with glucagon-like peptide 1 receptor agonist (GLP-1RA) and sodium-glucose co-transporter-2 (SGLT-2) inhibitor. Case Presentation: A 60-year-old lady with type 2 diabetes presented with uncontrolled blood sugars despite high doses of insulin and a combination of OHAs. She was also depressed and frustrated due to uncontrolled blood sugars despite repeated changes made in her treatment plan using an insulin pump along with GLP-1RA (dulaglutide) and SGLT-2 inhibitor (empagliflozin). Results: After changing the treatment plan, her HbA1c levels decreased from 10.1% to 7.3% after 3 months. The microalbuminuria reverted to normoalbuminuria (59.9–12.2 µg/mg of creatinine). Improvement has been observed in the fasting C-peptide levels from 0.50 to 0.86 pmol/L and stimulated C–C-peptide levels from 1.2 to 2.05 pmol/L. As she lost nearly 7 kg of weight, she felt satisfied with a better quality of life. Even her depression settled down. Conclusion: Use of CSII pump along with dulaglutide and empagliflozin helped in controlling blood sugars, bringing down weight with an overall improvement in mental health and renal function; in this, difficult to treat the patient.