菜单
This skill determines whether a patient using a hybrid closed-loop insulin pump can continue this therapy upon hospital admission. It is triggered by questions such as "Can hybrid closed-loop pump be continued given hospital constraints?"
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For a person with confirmed islet autoantibodies (early-stage type 1 diabetes), state the numerical progression risk to Stage 3 T1D by stage and age, set the age-stratified monitoring frequency (metabolic and HbA1c), apply the ≥10% longitudinal HbA1c rise → OGTT rule, and give the standard risk-modifier and communication framing. Use when a clinician asks how often should I monitor this Stage 1 child, what's the risk of this teenager progressing to insulin, adult with GAD positive what's the 5-year risk, my patient's HbA1c has risen 12% is that important, single autoantibody how often to retest, or how to counsel a family about progression risk. Grounded in Phillip et al. Diabetologia 2024 international staging and monitoring consensus, cross-referenced with Hussain et al 2026 IDF Europe roadmap.
Order and confirm islet autoantibody screening for early-stage type 1 diabetes — which antibodies to test (GAD65, IAA, IA2, ZnT8), sample types (capillary dried blood spot, venous), the mandatory two-sample two-method confirmation protocol, and how to interpret a positive, negative, or single-antibody result. Use when a clinician asks how to screen for early T1D, which islet autoantibodies to order, how to confirm a positive T1D antibody screen, is one autoantibody enough for T1D diagnosis, GAD antibody positive what next, or is running a general population or family-history T1D screening program. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
Classify a person with a positive islet autoantibody screen into a specific stage of type 1 diabetes (At Risk / Stage 1 / Stage 2a / Stage 2b / Stage 3a / Stage 3b / Stage 4) using the international consensus staging framework based on autoantibody count and glycaemic status. Use when a clinician asks how to stage a positive autoantibody screen, what stage of T1D is this, is this early-stage T1D, does this child need insulin yet, is this presymptomatic T1D, does this qualify for teplizumab, or presents a person with any combination of islet autoantibodies + glucose data. Applies across paediatric and adult populations. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
基于 SOC 职业分类
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| name | es-pump-hybrid-continuation |
| description | This skill determines whether a patient using a hybrid closed-loop insulin pump can continue this therapy upon hospital admission. It is triggered by questions such as "Can hybrid closed-loop pump be continued given hospital constraints?" |
Collect data on pump type (hybrid closed-loop), baseline settings, CGM status, anticipated hospital LOS, contraindications (impaired consciousness, inability to adjust pump, critical illness, DKA, HHS), hospital resources (expertise in insulin pump therapy, policies, supplies), and potential interference (MRI/CT, vasoactive meds, skin infection/hypoperfusion, acetaminophen >4 g/day, dopamine, vitamin C, hydroxyurea). Flag any absolute contraindications to pump use.
Determine if continuation is feasible: (hospital has expertise in insulin pump therapy) OR (anticipated LOS ≤1‑2 days). If YES, proceed to assess pump/CGM function; if NO, transition to scheduled subcutaneous basal bolus insulin (BBI) therapy.
Assess whether CGM and pump can function without hospital interference. If YES, continue hybrid closed-loop with CGM guidance. If NO (interference expected or CGM likely to fail), evaluate if pump can be used in manual mode (patient able to adjust settings, supplies available, no contraindications). If manual mode feasible, plan for manual pump use; if not, transition to SC BBI.
If CGM/pump functional without interference: continue hybrid closed-loop therapy with CGM-guided adjustments. If CGM/pump not functional but manual mode feasible: continue insulin pump in manual mode with patient self-management and POC‑BG confirmation. If neither feasible: transition to scheduled subcutaneous basal bolus insulin (BBI) therapy.
Do not continue pump if patient has impaired consciousness, inability to adjust pump settings, critical illness (ICU), DKA, HHS, or if hospital lacks expertise and anticipated LOS >1‑2 days without a transition plan. Avoid interference from MRI/CT, vasoactive pressors, acetaminophen >4 g/day, dopamine, vitamin C, hydroxyurea. Do not assume pump will work without verifying supplies, patient consent, and ability to self‑manage.
A 58‑year‑old patient with type 1 diabetes using a hybrid closed‑loop pump is admitted for elective surgery. Hospital has pump expertise, anticipated LOS 2 days, no contraindications, no expected interference. Continue hybrid closed‑loop pump with CGM guidance.
Source: Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, https://doi.org/10.1210/clinem/dgac278