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Longitudinal Observation of Insulin Use and Glucose Sensor Metrics in Pregnant Women with Type 1 Diabetes Using Continuous Glucose Monitors and Insulin Pumps: The LOIS-P Study

O'Malley, Grenye ; Ozaslan, Basak ; Levy, Carol J ; Castorino, Kristin ; Desjardins, Donna ; Levister, Camilla ; McCrady-Spitzer, Shelly ; Church, Mei Mei ; Kaur, Ravinder Jeet ; Reid, Corey ; Kremers, Walter K ; Doyle, Francis J ; Trinidad, Mari Charisse ; Rosenn, Barak ; Pinsker, Jordan E ; Kudva, Yogish C ; Dassau, Eyal

Diabetes technology & therapeutics, 2021-12, Vol.23 (12), p.807-817 [Periódico revisado por pares]

United States: Mary Ann Liebert, Inc

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  • Título:
    Longitudinal Observation of Insulin Use and Glucose Sensor Metrics in Pregnant Women with Type 1 Diabetes Using Continuous Glucose Monitors and Insulin Pumps: The LOIS-P Study
  • Autor: O'Malley, Grenye ; Ozaslan, Basak ; Levy, Carol J ; Castorino, Kristin ; Desjardins, Donna ; Levister, Camilla ; McCrady-Spitzer, Shelly ; Church, Mei Mei ; Kaur, Ravinder Jeet ; Reid, Corey ; Kremers, Walter K ; Doyle, Francis J ; Trinidad, Mari Charisse ; Rosenn, Barak ; Pinsker, Jordan E ; Kudva, Yogish C ; Dassau, Eyal
  • Assuntos: Benchmarking ; Blood Glucose - analysis ; Blood Glucose Self-Monitoring ; Diabetes ; Diabetes Mellitus, Type 1 - drug therapy ; Drug delivery systems ; Female ; Glucose ; Glucose monitoring ; Humans ; Hypoglycemic Agents - therapeutic use ; Infant ; Infant, Newborn ; Insulin ; Insulin - therapeutic use ; Original ; Pregnancy ; Pregnant Women ; Sensors ; Womens health
  • É parte de: Diabetes technology & therapeutics, 2021-12, Vol.23 (12), p.807-817
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
    xORCID ID (https://orcid.org/0000-0003-4080-9034).
    These authors contributed equally to this work.
    viORCID ID (https://orcid.org/0000-0003-3393-2042).
    Preliminary data was previously presented at American Diabetes Association 80th Scientific Sessions. June 2020. Poster 1383-P.
    ixORCID ID (https://orcid.org/0000-0002-3293-9114).
    vORCID ID (https://orcid.org/0000-0002-9278-1099).
    viiiORCID ID (https://orcid.org/0000-0001-5714-3473).
    xiiORCID ID (https://orcid.org/0000-0001-5333-6892).
    iORCID ID (https://orcid.org/0000-0001-7940-2624).
    iiORCID ID (https://orcid.org/0000-0002-8537-1892).
    ivORCID ID (https://orcid.org/0000-0001-6386-9203).
    iiiORCID ID (https://orcid.org/0000-0002-3492-2578).
    xiORCID ID (https://orcid.org/0000-0003-0285-6622).
    viiORCID ID (https://orcid.org/0000-0001-6445-2776).
  • Descrição: Suboptimal glycemic control is associated with maternal and neonatal morbidity and mortality in pregnancy complicated by type 1 diabetes (T1D). Prospective analysis of continuous glucose monitoring (CGM) metrics, insulin pump settings, and insulin delivery can better characterize the changes in glycemic levels and insulin use throughout pregnancy with T1D. Prescribed parameters, insulin delivery, carbohydrate intake, and CGM data for 25 pregnant women with T1D from three U.S. sites were collected. Participants enrolled before 17 weeks gestation and used personal insulin pumps and study CGM. Mean daily total, basal, and bolus insulin doses (units/kg), CGM time in range (TIR: 63-140 mg/dL), and pump-entered carbohydrates were analyzed for every 2-week gestational interval. Linear mixed-effects regression models were used to evaluate changes across gestational ages compared to 12-14 weeks. Basal insulin was higher during weeks 6-12 and 24-40. Daily bolus and total insulin were higher during weeks 20-40. Pump parameters were adjusted to intensify insulin therapy from 22 weeks onward. Average TIR across pregnancy was 59% ± 14%. Between 18 and 30 weeks, TIR was significantly lower, and time above range was significantly higher compared to the reference biweek. Time below target was lower between 22 and 34 weeks. Seven participants achieved >70% recommended TIR for pregnancy. Participants with maternal complications or infant neonatal intensive care unit admissions had lower TIR. While insulin dosing changed significantly with advancing gestation, most participants did not achieve >70% TIR. Customized anticipatory pump setting adjustments and automated systems aimed toward the designated TIR are needed to improve outcomes for this population. NCT03761615.
  • Editor: United States: Mary Ann Liebert, Inc
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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