Endocrine Abstracts

Introduction: Pregnancy in women with pre-existing Type 1 diabetes (T1DM) is known to carry a 3–5 times increased frequency of severe hypoglycaemia (SH) in the first compared to the third trimester. The main predictors are: pre-gestational SH, HbA1C <6.5%/48 mmol/mol, duration of diabetes and higher total daily insulin doses. Freestyle Libre or flash monitoring utilizes a 14 day tiny glucose sensor which is applied to the back of the arm and scanned with a reader, to obtain a glucose reading and excursion direction. Recent data where Freestyle Libre was used in Type 1 diabetics demonstrated a statistically significant reduction: in number of hours spent in hypoglycaemia (by 38%), nocturnal hypoglycaemia (40%), and SH (50%) without an increase in HbA1C at 6 months (IMPACT study). The Evaluation of Freestyle Libre (FL) – in Pregnancy Study (FLIPS) data is awaited.

Method: Three pregnant women with pre-existing T1DM from the high risk ANC were managed with FL. Two had undergone diagnostic trial and purchased their own systems. Impaired hypoglycaemia awareness being the primary indication. Standard capillary glucose monitoring was used alongside FL.

Results: Overall an improvement in: HbA1C, hypoglycaemia frequency, reported patient satisfaction, were noted. More extensive capillary glucose monitoring was prompted in all. Concerns over the low FL readings at 48 h lead to discontinuation in one patient.

Conclusion: The FL systems appear to be a useful tool in the management of complex T1DM pregnancies. Caveats: patient selection and ongoing capillary blood glucose monitoring. FL prompted pregnant patients to check capillary blood glucose more often thus avoiding hypoglycaemia.