Poster Session 2
Lucas G. Miranda-Martinez, BA (he/him/his)
Medical Student (MS3)
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Molly Beestrum, MS
Librarian, Education and Curriculum Coordinator
Galter Health Sciences Library, Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Charlotte M. Niznik, RN
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Lynn M. Yee, MD, MPH (she/her/hers)
Associate Professor
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Stephanie A. Fisher, MD, MPH (she/her/hers)
Assistant Professor of Obstetrics and Gynecology
Northwestern University Feinberg School of Medicine
Chicago, IL, United States
Hybrid closed-loop (HCL) therapy, which integrates an insulin pump with a continuous glucose monitor to automatically adjust basal insulin rates, improves glycemic control in non-pregnant individuals with type 1 diabetes (T1DM). Although it is not yet approved for pregnancy, recent studies suggest potential benefits to HCL in pregnant people with T1DM. This meta-analysis aims to evaluate clinical outcomes associated with HCL vs. standard therapy (ST) during pregnancy.
Study Design:
In this meta-analysis, a predefined, systematic, librarian-assisted search of Ovid MEDLINE, Embase, Scopus, Cochrane, ClinicalTrials.gov, and World Health Organization International Clinical Trial Registry Platform initially yielded 295 studies related to HCL in pregnancy. Glycemic metrics (time-in-range, TIR [63-140mg/dL]; time-above-range, TAR; time-below-range, TBR; coefficient of variation, CV; mean glucose; hemoglobin A1c, HbA1c), were compared by trimester in those exposed to HCL vs. ST (i.e. sensor-augmented pump therapy or multiple daily injections). Maternal and neonatal outcomes were secondarily assessed. We calculated standardized mean differences (SMD) and pooled odds ratios (OR) with 95% confidence intervals (CI) using random effects models.
Results:
Five studies (3 randomized trials, 1 prospective cohort, 1 case series) published from 2022-24 met eligibility criteria and evaluated 183 pregnancies exposed to HCL vs. 178 exposed to ST. TIR and TAR did not differ by HCL vs. ST in any trimester (Table 1). TBR was lower with HCL use in the 2nd (-1.1% [-2.2%, -0.03%]) and 3rd (-1.4% [-1.9%, -0.8%]) trimesters. CV was also lower with HCL use in the 1st (33.8 vs. 36.1%, SMD -2.6% [95%CI -4.3%, -0.8%]), 2nd (31.6% vs. 33.6%, SMD -2.1% [95%CI -2.9%, -1.3%]), and 3rd (29.1% vs. 30.9%, SMD -1.5% [95%CI -2.2%, -0.8%]) trimesters. Maternal and neonatal outcomes did not differ between groups (Table 2).
Conclusion:
Use of HCL for pregnant people with T1DM is associated with lower TBR and glycemic variability, with similar maternal and neonatal outcomes, suggesting a potential safety benefit that warrants further study.