1424-P: Changes in Device Uptake and Glycemic Control among Pregnant Women with Type 1 Diabetes: Data from the T1D Exchange

Abstract

We examined characteristics of pregnant women aged 16-40 years with type 1 diabetes (T1D) enrolled in the T1D Exchange clinic registry. We compared characteristics of 3 cohorts of women with data collection periods from: 2010-12 (N=4651), 2011-13 (N=3355), and 2016-18 (N=2818). 2.9%, 2.2%, and 1.7% of women reported being pregnant during 2010-12, 2011-13, and 2016-18, respectively. For pregnant women, there was a trend for a decrease in HbA1c over the 3 time periods from 6.8% to 6.7% to 6.4% (P=0.13 adjusted for age, race/ethnicity, frequency of glucose monitoring, and use of CGM). Self-reported use of CGM while pregnant increased more than 2-fold over the time period (P=0.001 adjusted for age, duration, race/ethnicity, insurance status, and use of pump); conversely, self-reported pump use while pregnant remained unchanged (adjusted P=0.38) (Table). Severe hypoglycemia (seizure/loss of consciousness) was similar across cohorts (adjusted P=0.38).We found in a real-world population of pregnant women in the U.S., lower HbA1c levels compared to those pregnant 5-6 years ago. CGM use in pregnancy appears to have increased over time, with relatively low but stable participant-reported insulin pump use. Further explorations of these findings, ongoing assessment of real-world pregnancy outcomes and comparisons with data on T1D pregnant women from other large registries are needed. Disclosure C.J. Levy: Advisory Panel; Self; Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Allergan. N.C. Foster: None. S. DuBose: None. S. Agarwal: None. S. Lyons: None. A.L. Peters: Advisory Panel; Self; Abbott, Becton, Dickinson and Company, Bigfoot Biomedical, Eli Lilly and Company, Lexicon Pharmaceuticals, Inc., Livongo Health, MannKind Corporation, Medscape, Merck & Co., Inc., Omada Health, Inc., OptumRx, Inc., Sanofi US, Zafgen, Inc. Research Support; Self; AstraZeneca, Dexcom, Inc., Jaeb Center for Health Research, MannKind Corporation, National Institute of Diabetes and Digestive and Kidney Diseases. Speaker's Bureau; Self; Novo Nordisk Inc. G.I. Uwaifo: None. L. DiMeglio: Research Support; Self; Amgen Inc., Caladrius Biosciences, Inc., Janssen Research & Development, Medtronic, Sanofi. Other Relationship; Self; Dexcom, Inc. J. Sherr: Advisory Panel; Self; Bigfoot Biomedical, Eli Lilly and Company, Insulet Corporation. Consultant; Self; Lexicon Pharmaceuticals, Inc., Medtronic, Sanofi. Research Support; Self; Dexcom, Inc., Insulet Corporation. S. Polsky: Consultant; Self; Jaeb Center for Health Research. Research Support; Self; Barbara Davis Center for Diabetes, Children's Diabetes Foundation, Dexcom, Inc., Eli Lilly and Company, JDRF, Leona & Harry Helmsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Sanofi US. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Performance of the Dexcom G6 Continuous Glucose Monitoring System in Pregnant Women with Diabetes

“…These improvements have contributed to increasing numbers of patients who use CGM, and higher proportions of time in which the devices are used. 22 In particular, self-reported rates of CGM usage among pregnant or recently pregnant women with diabetes have rapidly increased over the past decade. In 2010–2013, 36% of the 214 women who participated in the T1D Exchange Clinic Network and Registry in the United States and were pregnant at enrollment or at year-1 follow-up (recently pregnant) reported using CGM.…”

“… 23 By 2016–2018, 70% of pregnant women participating in the T1D Exchange reported using CGM during pregnancy. 22 …”

Leveraging technology for the treatment of type 1 diabetes in pregnancy: A review of past, current, and future therapeutic tools

“…19,21,67,68 Reflecting these recommendations, self-reported CGM use in pregnant women with T1D increased significantly among US survey participants in a T1D Exchange study from 37% in 2010-2013 to 70% in 2016-2018. 36 This temporal change was also associated with a downward trend in HbA1c.…”

“…Because this area is understudied, care providers have limited evidence-based data to guide management recommendations. 13,35,36 3 | GLYCEMIC MONITORING IN PREGNANCY: URINE GLUCOSE AND SMBG…”

Glycaemic control and novel technology management strategies in pregestational diabetes mellitus

“…Despite this more than 80% would recommend rtCGM and a similar proportion would use it again ( 60 ). This increased use and popularity of rtCGM also carries implications for healthcare providers ( 61 ). The analysis of rtCGM is resource intense and requires dedicated time with each patient.…”