Background:
Adverse pregnancy outcomes correlate with blood glucose levels in women with type 1 diabetes. There is a gap between glycaemic targets and blood glucose control achieved in pregnancy.
Aims:
To investigate the impact of an intensive weekly service on glycaemic control compared with our previous care model in pregnancies affected by type 1 diabetes.
Materials and Methods:
This is a retrospective cross-sectional pre / post study comparing measures of glycaemic control in women with type 1 diabetes at each trimester of pregnancy, in the 12 months before and the 8 months after the commencement of an intensive weekly insulin stabilisation service (ISS).
Results:
The study utilised data from Dexcom continuous glucose monitoring (CGM) reports for analysis of pregnancy-specific glycaemic data (incorporating time in range 3.5-7.8 mmol/L). 16 women provided data for 35 trimesters pre ISS and 17 women provided data for 38 trimesters post ISS. There was an improvement in pregnancy-specific time-in-range for trimester 3 following the commencement of an intensive weekly insulin stabilization service (mean pre 49.6%, post 61.4%, p=0.042). Similar results were seen when women using hybrid closed loop technology were excluded, albeit not then reaching statistical significance.
It was not possible to assess the effect of the intervention on the first trimester.
There were no statistically significant changes in glycaemia for trimester 2.
Conclusions:
In a small group of pregnant women with type 1 diabetes, improvement in pregnancy specific time-in-range occurred in trimester 3, but not in trimester 1 or 2, following the introduction of intensive weekly clinical support.