Continuous Insulin Infusion Pump Improves Pregnancy Outcomes for Diabetic Patients
Diabetic patients with pregestational diabetes may experience improved pregnancy outcomes when using a continuous subcutaneous insulin infusion pump paired with a continuous glucose monitor (CGM), according to a recent study. The use of these tools has been associated with a reduction in maternal and neonatal morbidity, offering hope for expectant mothers with diabetes.
The study, led by Dr. Neil Hamill, a maternal-fetal medicine specialist at Methodist Women’s Hospital in Omaha, Nebraska, aimed to address the high incidence of maternal and fetal disease among diabetic patients. Dr. Hamill and his colleagues analyzed data from 55 pregnant patients with pregestational diabetes who received care at the Women’s Hospital Perinatal Center at the Nebraska Methodist Health System between October 2019 and October 2022. All participants required insulin prior to week 20 of pregnancy and used CGMs for more than two weeks. The study’s healthy benchmark set blood glucose levels at less than 140 mg/dL.
The findings revealed that participants who had severe preeclampsia, delivered prematurely, had neonates with respiratory distress syndrome, or gave birth to larger-than-expected infants spent less time in the safe zone with a blood glucose level below 140 mg/dL compared to women without these risk factors. Improved blood sugar control translated to better maternal and fetal outcomes, emphasizing the importance of effective diabetes management during pregnancy.
Dr. Neetu Sodhi, an ob/gyn at Providence Cedars-Sinai Tarzana Medical Center in Los Angeles, expressed optimism regarding the potential for blood glucose monitors and insulin pumps to enhance outcomes for pregnant patients with pregestational diabetes. She believes that patients should have access to such devices, which have proven to significantly improve health outcomes, as demonstrated by this study.
However, Dr. Mark Ebell, a professor of epidemiology at the University of Georgia in Athens, expressed some skepticism about the study’s conclusions. He pointed out that the participants may have employed additional methods alongside the technology to lower their blood sugar levels, potentially impacting the overall outcomes observed.
Despite differing opinions, the study suggests that insulin pumps offer a more manageable alternative to multiple daily self-injections for diabetic pregnant women. Diabetes affects approximately one in nine women in the United States, with 35% of newly diagnosed cases occurring in women of reproductive age. Consequently, the use of insulin pumps can help alleviate the burdens faced by these expectant mothers.
Dr. Hamill emphasized the need for further research to define a stricter criterion for baseline blood sugar levels as well as to determine the optimal amount of time patients should spend below that level for the best outcomes. He also highlighted the uncertainties surrounding the benefits of these technologies for patients with gestational diabetes due to the limited duration of the condition and associated risks and costs involved in their use.
Dr. Sodhi suggested that clinicians should review morbidities and medical problems related to diabetes during family planning visits to address these challenges effectively. While she acknowledged that the study might be in its early stages, she believes that with more research, a strong case can be built for incorporating blood glucose monitors in young patients to optimize pregnancy outcomes.
In conclusion, the study highlights the potential benefits of using continuous subcutaneous insulin infusion pumps in combination with continuous glucose monitors for pregnant patients with pregestational diabetes. This technology has demonstrated the ability to improve maternal and neonatal outcomes and reduce the prevalence of maternal and fetal disease. Further research is needed to establish precise guidelines and determine the full extent of its benefits for patients with gestational diabetes. Ultimately, optimizing blood sugar control during pregnancy is crucial in reducing risks and improving overall outcomes for diabetic patients.
Source: J Matern Fetal Neonatal Med. Published online July 19, 2023.
