Endocrine Abstracts (2015) 38 S8.1 | DOI: 10.1530/endoabs.38.S8.1

Revolutionising type 1 diabetes metabolic control in pregnancy

Helen Murphy1,2, Zoe Stewart3 & Roman Hovorka3

1University of East Anglia, Norwich, UK; 2Cambridge University NHS Foundation Trust, Cambridge, UK; 3University of Cambridge, Cambridge, UK.

Continuous glucose monitoring (CGM) has highlighted the gap that exists between our expectations of tight metabolic control and the realities of actually achieving this, particularly during type 1 diabetes pregnancy. Longitudinal measurements indicate that despite overall ‘good’ HbA1c levels, pregnant women with type 1 diabetes spend 8 h/day with blood glucose levels above the recommended targets. New closed-loop (CL) or artificial pancreas approaches integrate insulin pump delivery (CSII) with CGM via computerized algorithms.

The vital component of a CL system for use during pregnancy is a control algorithm which can function safely despite the physiological changes in glucose turnover, endogenous glucose production, and insulin kinetics. We have defined these changes in type 1 diabetes pregnancy and completed proof-of-concept phase I feasibility studies evaluating overnight CL, in early (12–16 weeks) and late (28–32 weeks) gestation. Pilot feasibility studies demonstrated near-normal overnight glucose control (85–100% time within the target range of 3.5–7.8 mmol/l), during early and late gestation. In a subsequent 24-h crossover study comparing CL vs conventional CSII, CL achieved excellent overnight control (95–100% time in target), with 80% overall time in target, during meals, snacks and physical activity. Phase II unsupervised home studies evaluating the feasibility, safety and efficacy of CL in real-life home settings are currently underway with encouraging preliminary data.

The next challenge is to translate promising preliminary results into real-life benefits for mothers with type 1 diabetes and their offspring.

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