Individualised Assessment and Management of Diabetes in Pregnancy

Lee, Tara (2025) Individualised Assessment and Management of Diabetes in Pregnancy. Doctoral thesis, University of East Anglia.

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Abstract

Background
Type 1 diabetes in pregnancy is associated with an increased risk of complications for both mother and fetus. Maternal glycaemia is a major modifiable risk factor in reducing these risks, however, despite improvements in diabetes management, rates of complications remain high. Outside of pregnancy, hybrid closed-loop therapy is associated with improved glycaemia for adults and children with type 1 diabetes. Whilst hybrid closed-loop therapy shows promise for managing type 1 diabetes during and immediately after pregnancy, its clinical efficacy remains unclear. Furthermore, currently guidelines do not specifically address the postpartum period when further challenges including the demands of caring for a newborn are great.

Objectives
To evaluate the clinical efficacy and safety of hybrid closed-loop therapy compared to continuous glucose monitoring and standard insulin therapy during pregnancy and the first six months postpartum.

Methods
We performed a multicentre parallel-group controlled trial where pregnant women with type 1 diabetes were randomised to continue standard insulin therapy with continuous glucose monitoring or to hybrid closed-loop therapy. Assigned treatments were continued from randomisation in early pregnancy until six months’ postpartum.

Findings
CamAPS FX hybrid closed-loop therapy improves maternal glycaemia during pregnancy and the first six months’ postpartum (10.5% and 15% respectively). Women using hybrid closed-loop during pregnancy gained less weight and developed fewer hypertensive disorders. Women reported preference for hybrid closed-loop over standard insulin therapy during pregnancy and into the postpartum period. Trial healthcare professionals also supported hybrid closed-loop therapy as standard of care for the management of type 1 diabetes during pregnancy.

Conclusions
My research has demonstrated that hybrid closed-loop is an effective treatment option providing clinical advantage over and above continuous glucose monitoring with standard insulin therapy. These results informed the NICE technical appraisal recommendations that hybrid closed-loop therapy should be offered to all pregnant women with type 1 diabetes.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	03 Dec 2025 12:00
Last Modified:	03 Dec 2025 12:00
URI:	https://ueaeprints.uea.ac.uk/id/eprint/101221
DOI:

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