Minimal change disease in a patient with type 1 diabetes and Crohn's disease managed with advanced hybrid closed-loop insulin therapy during corticosteroid treatment.

A 67-year-old woman with a 25-year history of type 1 diabetes mellitus and comorbid Crohn's disease developed rapidly progressive proteinuria, hypoalbuminemia, edema, and kidney dysfunction. Minimal change disease (MCD) was diagnosed on kidney biopsy. Mesalazine was discontinued, and prednisolone (PSL) at 50 mg/day (0.9 mg/kg) induced remission of MCD. During treatment, glycemic management markedly worsened, and multiple daily insulin injections failed to achieve adequate control. After edema improved and PSL was tapered to 35 mg/day, continuous subcutaneous insulin infusion was resumed, and advanced hybrid closed-loop (AHCL) therapy was initiated using the MiniMed™ 780G system. Consequently, time in range markedly increased, accompanied by a significant decrease in time above range without a clinically significant increase in time below range. During PSL tapering, hypoglycemia was successfully prevented through automated basal rate adjustment by the AHCL system, optimization of the carbohydrate-to-insulin ratio, extension of active insulin time, setting of temporary glucose targets, and supplemental carbohydrate intake. This case suggests that MCD should be considered in the differential diagnosis of patients with Crohn's disease or diabetes presenting with rapidly progressive proteinuria and kidney impairment. To prevent hypoglycemia and mitigate the limitations of automated delivery, device settings should be dynamically adjusted during steroid tapering to account for changes in insulin sensitivity. With this clinical management strategy, AHCL therapy may be an effective treatment option for steroid-induced hyperglycemia.