Supported Open-Source Automated Insulin Delivery for Management of Type 1 Diabetes in Pregnancy

Abstract

Background:

The tight glycemia required to optimize type 1 diabetes (T1D) pregnancy outcomes is difficult to achieve with standard insulin therapies. Automated insulin delivery (AID) offers an avenue to improve glycemia, but most available systems are not configurable to tight pregnancy glucose targets. Open-source AID may meet the needs of some pregnant women with T1D, but available data on its efficacy and safety in pregnancy are limited.

Methods:

This single-center retrospective study describes the glycemic and obstetric outcomes of pregnancies in which supported open-source AID (SOSAID) was used. Included patients had a pregnancy managed on SOSAID at BCDiabetes between January 2023 and October 2024 and consented for inclusion of their clinical data. Charts were reviewed to obtain comprehensive glycemic data, obstetric outcomes, and adverse events.

Results:

Ten patients, mean age 33 years, had a mean pre-pregnancy A1c of 6.7% (range 5.8%-8.0%). There were no episodes of DKA or severe hypoglycemia. Mean time-in-range (TIR_{63-140 mg/dL}) was 68% in trimester 2 and 70% in trimester 3. Seven patients commenced SOSAID during pregnancy, with their median 14-day TIR rising from 52% pre-SOSAID to 71% immediately after commencing SOSAID. There were no perinatal deaths or congenital anomalies. Pre-term delivery occurred in 1/10 and hypertensive disorders of pregnancy occurred in 2/10 women. Birthweight above 4 kg was present in 3/10, and neonatal hypoglycemia occurred in 4/10.

Conclusions:

SOSAID systems represent a promising tool for managing T1D in pregnancy and were successful in reaching target pregnancy glycemia in this single-center cohort.