medwireNews: Women with type 1 diabetes achieve better glycemic control after giving birth with hybrid closed loop (HCL) insulin delivery than with multiple daily injections, report UK researchers.
“These findings support the continued use of HCL into the postpartum period, when clinical care is fragmented and diabetes self-management is challenged by the constant new demands of caring for a newborn,” say Helen Murphy (University of East Anglia, Norwich) and co-workers.
The Automated insulin Delivery Amongst Pregnant women with Type 1 diabetes (AiDAPT) study previously demonstrated that use of a HCL system significantly improved maternal glycemic control compared with standard insulin therapy, resulting in the UK’s National Institute for Health and Care Excellence recommending their use before and during pregnancy, the team explains in The Lancet Diabetes & Endocrinology.
To determine whether HCL systems also offer a benefit to women in the first 6 months after giving birth, the researchers conducted an extension study at nine UK sites to determine the impact of HCL delivery on maternal glycemia from the day after delivery in 57 women who were asked to continue with their original AiDAPT treatment allocation of HCL delivery (n=28) or standard care with continuous glucose monitoring (n=29).
The participants were aged an average of 31 years and had a baseline early pregnancy glycated hemoglobin level of 7.6% (59.4 mmol/mol). The target glucose level range was 3.9–10.0 mmol/L (70–180 mg/dL), and this was measured between 0–3 months and 3–6 months.
In early pregnancy, the women using the HCL delivery system had a time in range (TIR) of 73% during early pregnancy and maintained this at 72% over the first 6 months postpartum, while the standard care participants had a decrease in their TIR from 70% in early pregnancy to 54% postpartum. This gave a significant average adjusted treatment difference of 15% in favor of the HCL system.
“Differences in glycaemia were apparent from the first 4 weeks postpartum and in each subsequent 4-week period following delivery, with consistently higher TIR for the HCL group,” Murphy et al emphasize.
Women using the HCL system also spent a significant 15% less time in the first 3 months postpartum with a glucose level above 10.0 mmol/L (>180 mg/dL) than those given standard care and achieved a “sustained reduction” between months 4 and 6, the researchers say.
These benefits were also accompanied by significantly lower glucose levels on average over the first 3 months and 3–6 months postpartum with HCL delivery than standard care. The two groups had comparable, low, and stable rates of hypoglycemia, with just one severe episode in the standard care arm, the team adds. There were no cases of postpartum diabetic ketoacidosis.
Murphy and co-authors note that women using the HCL system had comparable rates of breastfeeding at 6 months than those given standard care (36 vs 42%) but were less likely to be exclusively breastfeeding at discharge (39 vs 52%) or by 8–12 weeks postpartum (25 vs 43%).
“The first few weeks after birth, when women experience the most profound physiological and lifestyle transitions, often coincides with insufficient clinical input and oversight compared with the intensive support women receive during pregnancy,” the investigators observe.
They therefore believe that their findings show “postpartum continuation of [the HCL delivery system] use allows mothers to maintain target glycaemic control while navigating clinical care transitions and adjusting to life with a newborn.”
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Lancet Diabetes Endocrinol 2025; doi:10.1016/S2213-8587(24)00340-1
