Closed-loop insulin delivery during pregnancy complicated by type 1 diabetes

Murphy, Helen R, Elleri, Daniela, Allen, Janet M, Harris, Julie, Simmons, David, Rayman, Gerry, Temple, Rosemary, Dunger, David B, Haidar, Ahmad, Nodale, Marianna, Wilinska, Malgorzata E and Hovorka, Roman (2011) Closed-loop insulin delivery during pregnancy complicated by type 1 diabetes. Diabetes Care, 34 (2). pp. 406-411. ISSN 0149-5992

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Abstract

OBJECTIVE: This study evaluated closed-loop insulin delivery with a model predictive control (MPC) algorithm during early (12-16 weeks) and late gestation (28-32 weeks) in pregnant women with type 1 diabetes.  RESEARCH DESIGN AND METHODS: Ten women with type 1 diabetes (age 31 years, diabetes duration 19 years, BMI 24.1 kg/m(2), booking A1C 6.9%) were studied over 24 h during early (14.8 weeks) and late pregnancy (28.0 weeks). A nurse adjusted the basal insulin infusion rate from continuous glucose measurements (CGM), fed into the MPC algorithm every 15 min. Mean glucose and time spent in target (63-140 mg/dL), hyperglycemic (>140 to ≥ 180 mg/dL), and hypoglycemic (<63 to ≤ 50 mg/dL) were calculated using plasma and sensor glucose measurements. Linear mixed-effects models were used to compare glucose control during early and late gestation.  RESULTS: During closed-loop insulin delivery, median (interquartile range) plasma glucose levels were 117 (100.8-154.8) mg/dL in early and 126 (109.8-140.4) mg/dL in late gestation (P = 0.72). The overnight mean (interquartile range) plasma glucose time in target was 84% (50-100%) in early and 100% (94-100%) in late pregnancy (P = 0.09). Overnight mean (interquartile range) time spent hyperglycemic (>140 mg/dL) was 7% (0-40%) in early and 0% (0-6%) in late pregnancy (P = 0.25) and hypoglycemic (<63 mg/dL) was 0% (0-3%) and 0% (0-0%), respectively (P = 0.18). Postprandial glucose control, glucose variability, insulin infusion rates, and CGM sensor accuracy were no different in early or late pregnancy.  CONCLUSIONS: MPC algorithm performance was maintained throughout pregnancy, suggesting that overnight closed-loop insulin delivery could be used safely during pregnancy. More work is needed to achieve optimal postprandial glucose control.

Item Type: Article
Additional Information: © 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
Uncontrolled Keywords: adult,algorithms,biosensing techniques,blood glucose,circadian rhythm,type 1 diabetes mellitus,female,humans,hyperglycemia,hypoglycemic agents,insulin,insulin infusion systems,pregnancy,pregnancy in diabetics,reproducibility of results
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 25 May 2016 16:01
Last Modified: 22 Apr 2020 01:26
URI: https://ueaeprints.uea.ac.uk/id/eprint/59067
DOI: 10.2337/dc10-1796

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