Automated Insulin Delivery for Pregnant Women With Type 1 Diabetes: Where Do We Stand?
| Autor: | Benhalima K; Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium., Jendle J; Diabetes Endocrinology and Metabolism Research Centre, School of Medicine, Örebro University, Örebro, Sweden., Beunen K; Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium., Ringholm L; 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. |
|---|---|
| Jazyk: | angličtina |
| Zdroj: | Journal of diabetes science and technology [J Diabetes Sci Technol] 2024 Nov; Vol. 18 (6), pp. 1334-1345. Date of Electronic Publication: 2024 Jan 10. |
| DOI: | 10.1177/19322968231223934 |
| Abstrakt: | 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. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: KB received an unrestricted grant and study devices from Medtronic for the investigator-initiated CRISTAL study. KB received study devices from Dexcom for the investigator-initiated GLORIA study. KB received study medication from Novo Nordisk A/S for the investigator-initiated SERENA study. KB received speaker fee from Novo Nordisk, AstraZeneca and Medtronic. KaatB has no disclosures. LR received a grant from Novo Nordisk A/S for an investigator sponsored study. Grant number: U1111-1209-6358 and participated in the European Association for the Study of Diabetes annual meeting 2023 as an invite by Novo Nordisk A/S. JJ has been a lecturer/member of the scientific advisory board in the following companies: Abbott, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Medtronic, Nordic InfuCare, NovoNordisk A/S, and Sanofi. KB received a fundamental clinical investigatorship from FWO Flanders (1800220N). |
| Databáze: | MEDLINE |
| Externí odkaz: |
|