Endocrine Abstracts

Objectives: Pregnant women with type 1 diabetes (T1D) are associated with an increased risk of maternal fetal complications. Continuous subcutaneous insulin infusion [CSII] has been shown to improve metabolic control and perinatal morbidity. Few studies have compared the use of CSII with SAP (sensor augmented pump) therapy to flash glucose monitoring (FSL) in pregnant women with T1D. We aim to evaluate the possible differences between both monitoring systems associated with CSII therapy and assess their effect on metabolic control during pregnancy and maternal-fetal morbidity.

Methods: This retrospective cohort study enrolled pregnant women with T1D on CSII treatment at a tertiary hospital between 2018 and 2022. We compared the SAP system (640G pump) with FSL monitoring (ISCI-FSL). Glucometric data of 14 days were obtained at every trimester of pregnancy from the different platforms (Carelink and Libreview); clinical and analytical data were obtained from medical records.

Results: were included 31 pregnant women with a mean age of 35 years and 20 years of T1D evolution. The SAP group (n=21) presented a higher percentage of pre-pregnancy control (80% vs 95.2%) and severe hypoglycemia in the 2 years prior to pregnancy (0 vs 28.6%), without significant differences (P>0,05). Regarding glycemic control, a longer time under range (<63 mg/dl) was evidenced in the ISCI-FSL group, both in the second (9.7 vs 5.8%, P=0.044) and in the third trimester (12.1 vs 5.6%, P=0.012), without statistically significant differences in time in range (63-140 mg/dl; 1stTrim 52.8 vs 54.8%, 2ndTrim 52.5 vs 55%, 3rdTrim 61.5 vs 63.9%) or in time over range (>140 mg/dl; 1st Trim 35.8 vs 36.6%, 2ndTrim 37.8 vs 39.2%, 3rd Quarter 26.4 vs 30.5%) between both groups. There were also no differences in HbA1c nor in the rate of severe hypoglycemia by trimester (table). Regarding neonatal complications, no significant differences were found in the incidence of macrosomia, neonatal hypoglycemia, malformations, and perinatal mortality, nor in the rate of maternal complications between both groups.

Conclusions: In this cohort of pregnant women with T1D on CSII therapy, FSL monitoring showed a longer time in hypoglycemia compared to the use of SAP, without finding other differences in metabolic control nor in maternal-fetal complications.