Moreno-Fernández Jesús, García-Seco José Alberto
Endocrinology and Nutrition Department, Ciudad Real University Hospital, Ciudad Real, Spain.
AACE Clin Case Rep. 2021 Jan 6;7(3):177-179. doi: 10.1016/j.aace.2020.11.039. eCollection 2021 May-Jun.
Hybrid closed-loop (HCL) devices can achieve tight glycemic control but are rarely used in pregnancy, which remains an off-label indication. We present a case of a pregnant patient with type 1 diabetes mellitus (T1DM) who used the Medtronic MiniMed 670G HCL system.
MiniMed 670G includes an advanced automode option (HCL therapy), which our patient used from the first trimester to the end of the pregnancy.
An unplanned pregnancy was detected in the T1DM patient, with a glycated hemoglobin level of 8.7 mmol/L (7.1%). The patient started sensor-augmented pump therapy at week 13. Subsequently, she entered automode (HCL) at week 16. The time in range (3.7-7.8 mmol/mol, 63-140 mg/dL) increased from 46.8% to 51.3% after HCL initiation. The glycated hemoglobin level remained close to 48 mmol/mol (6.5%) until the end of the pregnancy. Furthermore, the time under range (<3.7 mmol/mol, <63 mg/dL) remained below the optimal 4% level during the gestation. Finally, a healthy male baby was born at week 37. No safety events were recorded.
This case represents the successful off-label use of HCL during pregnancy in a patient with T1DM.
混合闭环（HCL）设备可实现严格的血糖控制，但在孕期很少使用，孕期使用仍属未获批准的适应证。我们报告一例1型糖尿病（T1DM）孕妇使用美敦力MiniMed 670G HCL系统的病例。
MiniMed 670G包括一种先进的自动模式选项（HCL疗法），我们的患者从孕早期至妊娠结束一直使用该模式。
该T1DM患者意外怀孕，糖化血红蛋白水平为8.7 mmol/L（7.1%）。患者在孕13周开始使用传感器增强型泵疗法。随后，她在孕16周进入自动模式（HCL）。启动HCL后，血糖达标时间（3.7 - 7.8 mmol/mol，63 - 140 mg/dL）从46.8%增至51.3%。直至妊娠结束，糖化血红蛋白水平一直维持在接近48 mmol/mol（6.5%）。此外，孕期血糖低于目标范围的时间（<3.7 mmol/mol，<63 mg/dL）一直低于最佳的4%水平。最后，患者在孕37周产下一名健康男婴。未记录到安全事件。
该病例代表了HCL在T1DM孕妇孕期成功的未获批准使用。
