Automated Insulin Delivery Improves Glucose Control in Pregnancy Complicated by Type 1 Diabetes

According to this study:Hybrid closed-loop insulin therapy is effective in nonpregnant adults and children with type 1 diabetes, but it isn't known whether the more stringent glucose targets required for optimal pregnancy outcomes can be achieved using this treatment. Researchers conducted a multicenter, randomized controlled trial to determine whether hybrid closed-loop insulin therapy started before 16 weeks' gestation would improve blood glucose levels in pregnant women with type 1 diabetes.A total of 124 women (mean age, 31.1 years; mean baseline glycated hemoglobin level, 7.7%) were randomized before 16 weeks' gestation to receive either automated hybrid closed-loop insulin delivery or standard insulin therapy. Both groups used continuous glucose monitoring.The percentage of time that glucose levels were within the pregnancy-specific target glucose range of 63 to 140 mg/dL from 16 weeks' gestation until delivery was 10.5 percentage points higher in the closed-loop group than in the standard-care group (68.2% versus 55.6%). Participants in the closed-loop group also had lower mean glucose and glycated hemoglobin levels and fewer nocturnal hypoglycemic events.There were six severe hypoglycemia events in the closed-loop group and five in the standard-care group. One diabetic ketoacidosis event occurred in each group. The rate of device-related adverse events was 24.3 per 100 person-years in the closed-loop group, with seven events related to closed-loop use and seven to the continuous glucose monitor.Benefits were seen soon after the initiation of closed-loop therapy, and use of the system remained high throughout pregnancy.The authors recommend that hybrid closed-loop therapy be offered to all pregnant people who have type 1 diabetes and suggest that starting it before or as soon as possible after confirmation of pregnancy may offer further benefits.They caution, however, that the sample size didn't provide definitive data on maternal and neonatal health outcomes, and first trimester data were limited. Also, the results may not apply to systems with higher glucose-level targets, they note.Hybrid closed-loop insulin therapy is effective during pregnancy that is complicated by type 1 diabetes.Participants receiving closed-loop therapy had lower mean glucose and glycated hemoglobin levels and fewer nocturnal hypoglycemic events than those receiving standard insulin therapy.