An international team of researchers, with the Australian trial led by Distinguished Professor David Simmons from the University's School of Medicine and Translational Health Research Institute has highlighted the benefits of an automated insulin delivery (AID) system in managing glucose levels for pregnant women with type 1 diabetes.
Led by the University of Calgary, the randomized trial, published in JAMA, found that pregnant women with type 1 diabetes who used the AID – a diabetes management system that automatically adjusts insulin delivery from an insulin pump based on data coming from real-time, day and night, glucose readings from a continuous glucose monitor (CGM) – spent on average, 3 hours longer each day in pregnancy-specific glucose range, a normal blood sugar target, versus those who received standard care of using an insulin pump or multiple daily insulin injections.
Distinguished Professor Simmons – also from Ingham Institute for Applied Medical Research and Campbeltown Hospital – said the results show the real-life impacts of this technology.
"For women with type 1 diabetes, the longer they spend in glucose range, the less likely they are to have adverse pregnancy outcomes such as large babies, preeclampsia, preterm births, and neonatal intensive care admissions so controlling glucose during pregnancy is important. Increasing glucose range for three hours a day is a clinically significant difference," said Distinguished Professor Simmons.
"Only one other AID was able to achieve this degree of improvement and we were excited by the results. Being able to adapt quickly to the increased insulin resistance, and changing insulin needs during pregnancy is complex, so this technology is significant. In Australia, we are very fortunate to have CGM provided at low cost, but unlike most other similar countries such as New Zealand, we still do not have the costs of an insulin pump covered and this study suggests that this should be reviewed."
The trial enrolled 94 pregnant women with type 1 diabetes at 14 clinical centres in Canada and Australia before 14 weeks' gestation with follow-up until 6 weeks postpartum. The primary outcome was the percentage of time spent in the pregnancy-specific glucose range (3.5-7.8 mmol/l, measured by continuous glucose monitoring from 16 to 34 weeks' gestation.
