A review of automated insulin delivery use in type 1 diabetes during pregnancy

Abstract

This review aimed to: (i) summarize the clinical evidence for automated insulin delivery (AID) use during pregnancy in people with pregestational diabetes, (ii) provide an overview of AID systems available in the US, and (iii) offer practical tips and considerations for clinicians working with pregnant patients on these systems. We synthesized findings from all six randomized controlled trials investigating AID use in people with pregestational type 1 diabetes. Some demonstrated better glycemic outcomes in patients using AID compared to sensor-augmented pump (SAP) therapy or standard insulin therapy. Others found no significant differences. Maternal and neonatal outcomes were similar to standard care, though some studies found that AID users had reduced gestational weight gain among other improvements. We also compared the features of six AID systems and shared clinical insights on how their settings can be adjusted to better meet pregnancy-specific glycemic targets. CamAPS FX is the only FDA-cleared AID system for use in T1D pregnancy, though it is not yet available in the US. While no AID system has demonstrated the ability to meet all pregnancy-specific glycemic targets, some systems are more customizable, making it easier to achieve the tighter glycemic targets in pregnancy. In conclusion, for pregnant women using AID systems, there are strategies and workarounds to aid in achieving pregnancy-specific glycemic targets. However, no system consistently meets all targets. More research is needed to understand how AID use during pregnancy impacts maternal and fetal outcomes and patient-reported outcomes, especially for pre-existing type 2 diabetes.

Keywords: Automated insulin delivery; concentrated insulin; glycemic outcomes; pregnancy; time in range; type 1 diabetes.