Hybrid closed loop insulin therapy effectively manages blood sugar among pregnant women with T1D

Diabetes itself is a risk factor in pregnancy, complicating up to 10% in the United States. Of these, 0.2% to 0.5% are patients with type 1 diabetes mellitus (T1DM). Reports suggest pregnancies affected by T1DM are at increased risk for preterm delivery, preeclampsia, macrosomia, shoulder dystocia, intrauterine fetal demise, fetal growth restriction, cardiac and renal malformations, in addition to rare neural conditions such as sacral agenesis.

Few studies report hybrid closed-loop insulin therapy has shown promise for management of type 1 diabetes during pregnancy; however, its efficacy is unclear. A new study in New England Journal of Medicine aimed to evaluate the same, and found that hybrid closed-loop therapy significantly improved maternal glycemic control during pregnancy complicated by type 1 diabetes.

Researchers conducted a multicenter, controlled trial, we randomly assigned pregnant women with type 1 diabetes and a glycated hemoglobin level of at least 6.5% at nine sites in the United Kingdom to receive standard insulin therapy or hybrid closed-loop therapy, with both groups using continuous glucose monitoring. The primary outcome was the percentage of time in the pregnancy-specific target glucose range (63 to 140 mg per deciliter [3.5 to 7.8 mmol per liter]) as measured by continuous glucose monitoring from 16 weeks’ gestation until delivery. Analyses were performed according to the intention-to-treat principle. Key secondary outcomes were the percentage of time spent in a hyperglycemic state (glucose level >140 mg per deciliter), overnight time in the target range, the glycated hemoglobin level, and safety events.