Emerging Technologies for the Management of Type 1 Diabetes in Pregnancy

Abstract

Purpose of Review The purpose of the study is to discuss emerging technologies available in the management of type 1 diabetes in pregnancy. Recent Findings The latest evidence suggests that continuous glucose monitoring (CGM) should be offered to all women on intensive insulin therapy in early pregnancy. Studies have additionally demonstrated the ability of CGM to help gain insight into specific glucose profiles as they relate to glycaemic targets and pregnancy outcomes. Despite new studies comparing insulin pump therapy to multiple daily injections, its effectiveness in improving glucose and pregnancy outcomes remains unclear. Sensor-integrated insulin delivery (also called artificial pancreas or closed-loop insulin delivery) in pregnancy has been demonstrated to improve time in target and performs well despite the changing insulin demands of pregnancy. Summary Emerging technologies show promise in the management of type 1 diabetes in pregnancy; however, research must continue to keep up as technology advances. Further research is needed to clarify the role technology can play in optimising glucose control before and during pregnancy as well as to understand which women are candidates for sensorintegrated insulin delivery.

Women’s Experiences of Day-and-Night Closed-Loop Insulin Delivery During Type 1 Diabetes Pregnancy

“…More widely, a recent review of technology in diabetes pregnancy highlighted uncertainty regarding the benefits of pump usage in terms of HbA1c and pregnancy outcomes. 5 Closed-loop systems represent the latest stage in diabetes technology evolution, building on established technologies such as CGM and CSII but seeking to reduce the cognitive burdens required for effective use of sensor-augmented pump therapy. Closed-loop systems utilize control algorithms to provide automated, CGM-responsive basal insulin delivery via an insulin pump every 10-15 minutes.…”

“…More widely, a recent review of technology in diabetes pregnancy highlighted uncertainty regarding the benefits of pump usage in terms of HbA1c and pregnancy outcomes. 5…”

“…Pregnant women with type 1 diabetes experience higher rates of fetal, maternal, and neonatal complications than the general maternity population of women without diabetes. [1][2][3][4][5] In England, structured antenatal care for women with pregestational diabetes involves frequent clinical contact (typically every 1-2 weeks) with specialist diabetes pregnancy health care teams. Together with strict glucose control before and during pregnancy, this care model allows treatment to be individually tailored to address physiological changes and can thus minimize diabetes-related risks during pregnancy.…”

Time trends in pregnancy-related outcomes among women with type 1 diabetes mellitus, 2004–2017

“…During the study period, there were significant changes in glucose management that include an increase in the use of insulin pumps and CGMs. Previous studies examining the efficacy of these techniques showed conflicting results [ 23 – 27 ]. We did not demonstrate any changes in mean HbA1C levels before and during pregnancy and the percentage of women with higher than recommended levels of HbA1c during pregnancy remained fairly high at 60–70%.…”

Gyermekvállalás és diabetes – 2019

“…További vizsgálatok szükségesek annak eldöntésére, hogy e rendszerrel elérhető-e az a glikémiás kontroll, amely a terhességi szövődmények megelőzéséhez szükséges. 38…”