Diabetology Outpatient Clinic , Asl Salerno, District 63, Salerno, Italy.
Diabetology Unit, San Paolo Hospital, ASL Roma 4, Civitavecchia, Rome, Italy.
Acta Diabetol. 2024 Sep;61(9):1185-1194. doi: 10.1007/s00592-024-02315-z. Epub 2024 Jun 7.
The use of most commercially available automated insulin delivery (AID) systems is off-label in pregnancy. However, an increasing number of women with type 1 diabetes (T1D) use such devices throughout pregnancy and delivery. We analysed the data of six women with T1D from a single centre (Diabetology Outpatient Clinic of District-63/Asl Salerno, Italy) who were able to start and maintain AID therapy with the MiniMed™ 780G (Medtronic, Minneapolis, MN, USA) throughout the pregestational care period, pregnancy, delivery, and postpartum.
We retrospectively collected data from six patients with T1D who received training and initiation on use of the MiniMed™ 780G and attended follow-up visits throughout pregnancy (these visits were virtual because of the COVID-19 pandemic). All patients maintained their devices in the closed-loop setting throughout pregnancy and during labour and delivery. We analysed data from the pregestational phase to the first 30 days postpartum.
All patients achieved the recommended metabolic goals before conception [median time in range (TIR) of 88% for 70-180 mg/dL; median pregnancy-specific TIR 63-140 mg/dL (ps-TIR) of 66% and maintained the ps-TIR until delivery (median ps-TIR 83%). All patients had slightly better metrics during the night than during the day, with a very low time below range of < 63 mg/dL. Optimal glycaemic values were also maintained on the day of labour and delivery (median ps-TIR 92.5%) and in the first 30 days postpartum, with no severe hypoglycaemia. The only neonatal complications were jaundice in one child and an interatrial defect in another child.
In our well-selected and trained patients, use of the MiniMed™ 780G helped to achieve and maintain ps-metrics from the pregestational period to delivery despite the fact that the algorithm is not set to achieve the ambitious glycaemic values recommended for pregnancy.
大多数市售的自动化胰岛素输注（AID）系统在妊娠期间的使用均为超适应证。然而，越来越多的 1 型糖尿病（T1D）女性在整个妊娠和分娩期间使用此类设备。我们分析了来自意大利萨勒诺第 63/Asl 区糖尿病门诊的 6 名 T1D 女性的数据，这些患者能够在整个妊娠前护理期间、妊娠、分娩和产后使用美敦力的 MiniMed™ 780G（明尼苏达州明尼阿波利斯）开始并维持 AID 治疗。
我们回顾性地收集了 6 名接受 MiniMed™ 780G 培训和启动使用的 T1D 患者的数据，并在整个妊娠期间进行了随访（由于 COVID-19 大流行，这些随访是虚拟的）。所有患者在整个妊娠期间以及分娩和分娩期间都将设备保持在闭环设置中。我们分析了妊娠前阶段至产后 30 天的数据。
所有患者在受孕前均达到了推荐的代谢目标[中位数 70-180mg/dL 范围内时间（TIR）为 88%；中位数妊娠特异性 TIR（ps-TIR）为 63-140mg/dL（ps-TIR）为 66%，并在分娩时维持 ps-TIR（中位数 ps-TIR 为 83%）。所有患者夜间的指标均优于白天，血糖低于 63mg/dL 的时间极短。分娩当天和产后 30 天的血糖控制也非常理想，没有严重的低血糖发作。唯一的新生儿并发症是一个孩子黄疸，另一个孩子房间隔缺损。
在我们精心选择和培训的患者中，尽管算法未设置为实现妊娠期间推荐的高血糖值，但使用 MiniMed™ 780G 有助于在妊娠前到分娩期间实现并维持 ps 指标。
