Treatment of Pregnant Type 1 Diabetes Patients with Continuous Subcutaneous Insulin Infusion: Tight Control Achieved with Unchanged Total Daily Insulin Dose Per Kilogram with Consecutive Basal/Prandial Insulin Ratio Adjustment

Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis

“…Eleven studies reported on maternal and neonatal outcomes associated with CSII, but did not include an MDI comparator arm, and thus were not included in the metaanalysis. 19,21,30,34,38,39,43,45,46,48,49 The remaining 28 studies compared perinatal outcomes according to each insulin administration modality among 5518 pregnant persons (3282 [59.5%] MDI vs 2,236 [40.5%] CSII) with pregestational DM and were quantitatively synthesized in the meta-analysis. 8,18,20,[22][23][24][25][26][27][28][29][31][32][33][35][36][37][40][41][42]47,[50][51][52][53][54][55] For the primary maternal outcome, CSII therapy was associated with greater odds of CD (20 studies: 63.24% vs 56.49%, OR 1.33 [95% CI 1.15-1.54]; Figure 2), with no significant heterogeneity between studies (I 2 = 0.0%, P = .58).…”

“…In addition, 12 studies reported on tobacco use, 18,24,26,28,30,32,35-37,41,50,55 four studies reported on preconception folic acid intake, 24,26,28,56 six studies reported on individuals having a history of diabetic neuropathy, 26,28,42,46,52,45 two studies reported on need for hospitalization for glycemic control, 22,26 seven studies reported on change in hemoglobin A1c from the first to third trimester, 27,28,42,45,46,48,55 and four studies reported on the change in daily insulin dose from the first to third trimester. 18,21,36,55…”

“…Six prospective observational cohort studies (including two secondary analyses of randomized controlled trials evaluating CGM therapy) and 33 retrospective cohort studies published from 2010 to 2022 met inclusion criteria and were selected for the systematic review (Figure 1 and Table 1). 8,18-55 In aggregate, the 39 studies included in the systematic review included 7528 pregnancies.…”

“…Eight studies reported on concomitant use of CGM. 8,21,28,37,41,48,55,45 Ten studies reported on type of basal and/or prandial insulin used, typically neutral protamine hagedorn (NPH) insulin, glargine, or detemir for basal insulin and lispro, aspart, or regular insulin for prandial insulin (Table 1). 18,23,24,31,34,36,39,42,46,49 Maternal characteristics with respect to maternal age, parity, BMI, long-term hypertension, complications related to pregestational DM, and glycemic control are available in Supplementary Tables 1 to 3.…”

“…In addition, 12 studies reported on tobacco use, 18,24,26,28,30,32,[35][36][37]41,50,55 four studies reported on preconception folic acid intake, 24,26,28,56 six studies reported on individuals having a history of diabetic neuropathy, 26,28,42,46,52,45 two studies reported on need for hospitalization for glycemic control, 22,26 seven studies reported on change in hemoglobin A1c from the first to third trimester, 27,28,42,45,46,48,55 and four studies reported on the change in daily insulin dose from the first to third trimester. 18,21,36,55 Tables 2 and 3 detail obstetric outcomes and other outcomes related to neonatal size (eg, birthweight, SGA, LGA, macrosomia, and shoulder dystocia) according to insulin administration modality, with 32 studies reporting on frequency of CD as the primary maternal outcome of interest. For secondary obstetric outcomes (Table 2), 17 studies reported on pregnancy loss prior to 20 weeks' gestation, 26 studies reported on PTB (including five studies reporting on PTB prior to 34 weeks' gestation), 22 studies reported on GWG, and 24 studies reported on HDP.…”