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Automated Insulin Delivery for Pregnant Women With Type 1 Diabetes: Where do we stand?
Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium.
Örebro University, School of Medical Sciences. Diabetes Endocrinology and Metabolism Research Centre, School of Medicine, Örebro University, Örebro, Sweden.ORCID iD: 0000-0003-1025-1682
Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium.
Center for Pregnant Women with Diabetes, Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
2024 (English)In: Journal of Diabetes Science and Technology, E-ISSN 1932-2968, Vol. 18, no 6, p. 1334-1345Article in journal (Refereed) Published
Abstract [en]

Automated insulin delivery (AID) systems mimic an artificial pancreas via a predictive algorithm integrated with continuous glucose monitoring (CGM) and an insulin pump, thereby providing AID. Outside of pregnancy, AID has led to a paradigm shift in the management of people with type 1 diabetes (T1D), leading to improvements in glycemic control with lower risk for hypoglycemia and improved quality of life. As the use of AID in clinical practice is increasing, the number of women of reproductive age becoming pregnant while using AID is also expected to increase. The requirement for lower glucose targets than outside of pregnancy and for frequent adjustments of insulin doses during pregnancy may impact the effectiveness and safety of AID when using algorithms for non-pregnant populations with T1D. Currently, the CamAPS® FX is the only AID approved for use in pregnancy. A recent randomized controlled trial (RCT) with CamAPS® FX demonstrated a 10% increase in time in range in a pregnant population with T1D and a baseline glycated hemoglobin (HbA1c) ≥ 48 mmol/mol (6.5%). Off-label use of AID not approved for pregnancy are currently also being evaluated in ongoing RCTs. More evidence is needed on the impact of AID on maternal and neonatal outcomes. We review the current evidence on the use of AID in pregnancy and provide an overview of the completed and ongoing RCTs evaluating AID in pregnancy. In addition, we discuss the advantages and challenges of the use of current AID in pregnancy and future directions for research.

Place, publisher, year, edition, pages
Diabetes Technology Society , 2024. Vol. 18, no 6, p. 1334-1345
Keywords [en]
Automated insulin delivery, continuous glucose monitoring, pregnancy, type 1 diabetes
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-110657DOI: 10.1177/19322968231223934ISI: 001229798100001PubMedID: 38197363Scopus ID: 2-s2.0-85181905511OAI: oai:DiVA.org:oru-110657DiVA, id: diva2:1826357
Funder
Medtronic, SwedenNovo Nordisk FoundationAstraZenecaAvailable from: 2024-01-11 Created: 2024-01-11 Last updated: 2024-11-06Bibliographically approved

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Jendle, Johan

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