Insulin delivery tech supports healthier pregnancies, study finds

Automated insulin delivery improves glucose control in pregnant women with type 1 diabetes, an international study has revealed.

The technology, which mimics a healthy pancreas, adjusts insulin from a pump in real time using current and predicted glucose.

Keeping glucose in range supports the health of both mother and baby.

An international clinical trial assessed hybrid closed-loop (HCL) insulin therapy — a form of automated insulin delivery that links a glucose sensor to a pump and adjusts doses automatically — against standard injections or non-automated pumps with continuous glucose monitoring.

Type 1 diabetes in pregnancy carries increased risks including miscarriage, pre-eclampsia (dangerous spikes in blood pressure) and other serious complications.

Babies face higher risks of being very large or premature, having low blood glucose at birth and experiencing birth defects.

The trial was co-led by the University of Calgary.

Dr Denice Feig is the study’s co-principal investigator, an endocrinologist and clinician scientist at the Lunenfeld-Tanenbaum Research Institute, Sinai Health, and professor of medicine at the University of Toronto.

The researcher said: “Keeping blood glucose in the optimal range for pregnancy is exceptionally challenging when someone has Type 1 diabetes, despite their best efforts and the support of dedicated health care clinics.”

The study found the automated system led to three additional hours each day within the desired glucose range compared with standard delivery methods.

“This is very important because we have learned from other larger studies that every 72 minute per day increase, with glucose in the desired range during pregnancy, is associated with reduction in newborn complications,” says Dr Lois Donovan, study co-principal investigator, endocrinologist at Foothills Medical Centre in Calgary and Cumming School of Medicine researcher.

The automated system used was a Tandem t:slim X2 insulin pump with Control-IQ technology.

Participants using the system spent more time in healthy glucose ranges and less time above or below target. Improvements were immediate and continued through pregnancy across all 14 trial sites.

“We’ve known for a while that AID systems have achieved better glucose control with less diabetes management burden in non-pregnant people with Type 1 diabetes, but its use had not been well studied in pregnancy,” Donovan said.

“Most AIDs were not designed to achieve the narrow glucose range desired in pregnancy or to adapt quickly enough to the changing insulin requirement of pregnancy.”

The trial involved clinics in Calgary, Toronto, Vancouver, Quebec City, London (Ontario), Winnipeg, Halifax, as well as Canberra, Melbourne and Sydney.

“This finding will help inform people who are pregnant or planning pregnancy regarding the benefits of this AID system, which can help them achieve better glucose levels in pregnancy and hopefully better pregnancy outcomes” said Feig.