Caregiver Burden and an Artifact-Associated Glycemic Instability Cycle in Pediatric Hybrid Closed-Loop Therapy: A Case Report

Hybrid closed-loop (HCL) systems improve glycemic outcomes in pediatric type 1 diabetes but transform rather than eliminate caregiver burden in selected real-world contexts. This case-based analysis describes a selected 14-day real-world observation of a 10-year-old child using an HCL system. Despite improved glycemic stability, active nocturnal interventions were required in 85.7% of observed nights. A recurring pattern, described here as an "artifact-associated glycemic instability cycle," was identified in this single case as a hypothesis-generating observation: physical pressure-induced sensor inaccuracies triggered automated insulin suspension, subsequently leading to rebound hyperglycemia and requiring 18 manual corrections. Frequent and repetitive alarms resulted in sustained cognitive load and features suggestive of alarm fatigue. Contextual environmental factors, such as local cooling, further influenced sensor accuracy and system behavior. These findings emphasize that HCL burden shifts toward a high-vigilance supervisory role. Improving sensor artifact detection and alarm specificity is essential for reducing caregiver strain and enhancing the real-world usability of automated insulin delivery systems in pediatric care.