OBJECTIVE: Outside of pregnancy, advances in automated closed loop (AHCL) insulin delivery systems have lent to a paradigm shift. However, evidence supporting the use of this technology during pregnancy in real life setting is still scarce. The objective of this study is to describe the time in range (TIRp) between 63-140 mg/dl in patients with type 1 diabetes (T1D) treated with AHCL systems compared to other automated insulin infusion (AID) systems during pregnancy.
METHODS: A prospective observational study was conducted in women with T1D who started AID systems before or during pregnancy. AHCL users activated SmartGuard mode between 24 and 26 weeks of gestation with optimal settings (Target: 100 mg/dl and AIT:2 hours). Glycated hemoglobin (A1c), continuous glucose monitoring (CGM) metrics were assessed.
RESULTS: A total of 65 pregnant women with T1D, 46 patients on AID and 19 patients on AHCL systems were enrolled. The mean pre-conceptional A1c was 7.5 ± 1.3%, %TIR 62.4±15.5. The %TIRp increases progressively at 24 (60.3±15.9%) and 34 weeks (66.8±13.3%). The use of the AHCL system was associated with higher %TIRp in the second (63.3+11.4 vs. 59.3+17.2, p=0.437) and third (73.1+10.3 vs. 64.4+13.6, p=0.024) trimesters of pregnancy, the latter being statistically significant compared to other AID systems. During the third trimester, there was a significant reduction in TAR >140 mg/dl (19.4+11.5 vs. 33+14, p=0.006).
CONCLUSION: The use of AHCL systems in real-world setting in patients with T1D during pregnancy showed better glycemic control in the third trimester of pregnancy compared to other AID systems.
