Artificial-Pancreas Use Feasible in Pregnancy; Study Published

August 25, 2016

Results of the first-ever study to examine use of a closed-loop insulin-delivery system — the so-called "artificial pancreas" — in an outpatient home setting in pregnant women with type 1 diabetes have been published. The results show some success, with use of the closed-loop system reducing hyperglycemia on the order of 25%.

First reported at the Diabetes UK meeting in Glasgow in March, by Zoe Stewart, MD, and a PhD student from the Institute of Metabolic Science, University of Cambridge, United Kingdom, the findings of the small study in 16 patients are now published in the August 18 issue of the New England Journal of Medicine.

Her group had already demonstrated that the artificial pancreas effectively controls blood glucose in type 1 diabetic patients in both early and late pregnancy under closely supervised inpatient conditions. This newly published feasibility trial demonstrates the impact of overnight closed-loop insulin delivery in the real-life home setting among such patients.

Dr Stewart told Medscape Medical News in March that the best indicator of success in the trial was the fact that, after it finished, 14 out of the 16 women studied chose to keep using the artificial pancreas, 24 hours a day, 7 days a week, and use even extended to the period immediately after birth, without any problems.

"Our findings build on recent trials showing that a closed-loop system, as compared with sensor-augmented [insulin] pump therapy, improved glycemic control, without increases in hypoglycemic episodes or the insulin dose," the researchers state in their paper.

The glucose control achieved was similar to that obtained with artificial pancreas systems among patients who were not pregnant, they add.

Nevertheless, "larger trials of closed-loop therapy for a longer period are needed to evaluate the effects of this therapy on obstetric and neonatal outcomes" in pregnant women with type 1 diabetes, they conclude.

The study was supported by a grant from the National Institute for Health Research (NIHR), grants from Diabetes UK, Gates Cambridge Trust, and Jean Hailes for Women's Health and a grant from the NIHR Cambridge Biomedical Research Center and a Wellcome Strategic Award. Dr Stewart reports grant support from the Gates Cambridge Trust and Jean Hailes for Women's Health and nonfinancial support from Abbott Diabetes Care during the conduct of the study. Disclosures for the coauthors are available on the journal website.

Follow Lisa Nainggolan on Twitter: @lnainggolan1. For more diabetes and endocrinology news, follow us on Twitter and on Facebook.

N Engl J Med. 2016;375:644-654. Article

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