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. 2024 Oct;67(10):2154-2159.
doi: 10.1007/s00125-024-06227-z. Epub 2024 Jul 19.

Glycaemic patterns during breastfeeding with postpartum use of closed-loop insulin delivery in women with type 1 diabetes

Lois E Donovan  1   2   3 , Rhonda C Bell  4 , Denice S Feig  5   6 , Patricia Lemieux  7 , Helen R Murphy  8 , Ronald J Sigal  9   10   11 , Josephine Ho  12 , Heidi Virtanen  12 , Susan Crawford  13 , Jennifer M Yamamoto  14   15
Affiliations

Glycaemic patterns during breastfeeding with postpartum use of closed-loop insulin delivery in women with type 1 diabetes

Lois E Donovan et al. Diabetologia. 2024 Oct.

Abstract

Aims/hypothesis: This study aimed to describe the relationship between breastfeeding episodes and maternal glucose levels, and to assess whether this differs with closed-loop vs open-loop (sensor-augmented pump) insulin therapy.

Methods: Infant-feeding diaries were collected at 6 weeks, 12 weeks and 24 weeks postpartum in a trial of postpartum closed-loop use in 18 women with type 1 diabetes. Continuous glucose monitoring (CGM) data were used to identify maternal glucose patterns within the 3 h of breastfeeding episodes. Generalised mixed models adjusted for breastfeeding episodes in the same woman, repeat breastfeeding episodes, carbohydrate intake, infant age at time of feeding and early pregnancy HbA1c. This was a secondary analysis of data collected during a randomised trial (ClinicalTrials.gov registration no. NCT04420728).

Results: CGM glucose remained above 3.9 mmol/l in the 3 h post-breastfeeding for 93% (397/427) of breastfeeding episodes. There was an overall decrease in glucose at nighttime within 3 h of breastfeeding (1.1 mmol l-1 h-1 decrease on average; p=0.009). A decrease in nighttime glucose was observed with open-loop therapy (1.2 ± 0.5 mmol/l) but was blunted with closed-loop therapy (0.4 ± 0.3 mmol/l; p<0.01, open-loop vs closed-loop).

Conclusions/interpretation: There is a small decrease in glucose after nighttime breastfeeding that usually does not result in maternal hypoglycaemia; this appears to be blunted with the use of closed-loop therapy.

Keywords: Breastfeeding; Closed-loop insulin delivery; Continuous glucose monitoring; Hypoglycaemia; Insulin pump therapy; Type 1 diabetes.

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Figures

Fig. 1
Fig. 1
Glycaemic response to (a) nighttime breastfeeding (open-loop therapy, n=57 breastfeeding episodes; closed-loop therapy, n=70 breastfeeding episodes) and (b) daytime breastfeeding (open-loop therapy, n=103 breastfeeding episodes; closed-loop therapy, n=197 breastfeeding episodes). Data are presented as medians (central solid lines) and interquartile ranges (shaded areas); blue, open-loop therapy; orange, closed-loop therapy. In (a), p<0.01 for decreased in blood glucose within 3 h of the initiation of breastfeeding with use of closed-loop vs open-loop therapy
See this image and copyright information in PMC

References

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