Endocrine Abstracts

Introduction: Managing type 1 diabetes during pregnancy can be challenging. Stricter glycaemic targets are recommended due to maternal and fetal risks. The closed-loop system is an advanced technology more and more commonly used in type 1 diabetes control but rarely reported during pregnancy. We report the case of a patient with type 1 diabetes, treated with the Medtronic 780 G system during pregnancy.

Case Report: A G3P3A0 pregnant patient with type 1 diabetes since the age of 9 years. High glycaemic variability was reported in previous pregnancies when treated with insulin injections. The closed-loop system was activated before the third pregnancy. Pregnancy was reported at 7 weeks. At the beginning of pregnancy, her weight was 45 Kg and glycated hemoglobin (HbA1c) was 6.7%. At week 22, maternal weight was 50 kg, continuous glucose measure (CGM) indicated 70% of the time in range (TIR; 70–180 mg/dl), 5% of time <70 mg/dl, and 25% of time >180 mg/Dl, estimated HbA1C of 7.1% and coefficient of variation of 25%. At week 32, maternal weight was 54 kg, Improved glycaemic control with time spent in different ranges achieved as follows: <70 mg/dl: 1%, 70–180 mg/dl: 94%, and above the target in 5%, estimated HbA1C of 6.3% and a coefficient of variation of 24.3%. During the last month of pregnancy, her overall mean sensor glucose was 134 +/- 32 mg/dl with a coefficient of variation (CV) of 24.2%, and mean HbA1C of 6.5% indicating healthy glycaemic control. Her CGM metrics indicated 92% of the time in range (TIR; 70–180 mg/dl), 1% of time <70 mg/dl, and 7% of time >180 mg/dl. The end of pregnancy took place at week 38 via cesarean section, during which the closed loop was maintained with an 81% TIR, 19% TAR, and no hypoglycemia. In the immediate postpartum period, the automatic mode was not suspended and good glycaemic control was maintained. There were no obstetric complications. The newborn required temporary monitoring in the Neonatal Intensive Care Unit for hypoglycaemia that rapidly resolved within 24 hours. Otherwise, the newborn was healthy, weighting 3840 g. Both mother and baby were discharged on the third day after delivery.

Conclusion: The use of a closed-loop system during pregnancy was associated with decreased episodes of severe hypoglycaemia and better glycaemic control. Further clinical studies on the use of closed-loop systems in pregnancy, delivery, and immediate postpartum should be encouraged.