<em>How can Australia improve diabetes in pregnancy outcomes for women with type 1 and type 2 diabetes: a UK perspective</em>? — ASN Events

How can Australia improve diabetes in pregnancy outcomes for women with type 1 and type 2 diabetes: a UK perspective? (108300)

Helen R Murphy 1
  1. University of East Anglia, Norwich Research Park, NORFOLK, United Kingdom

The UK has benefitted from publicly available contemporary National Pregnancy in Diabetes (NPID) dataset, that has informed patients and clinicians, at local clinics, across regional networks and nationally. Data from NPID inform NICE guidelines and national policy. Data from 15,480 pregnancies (N=6,595 T1D, N=8,140 T2D) will be reviewed, examining changes in maternal demographics, pregancy preparation, and obstetric and neonatal outcomes. The real-world impact of the national implementation of Continuous Glucose Monitoring (CGM) use, including real-time and intermittently scanned (is) CGM will be examined in 5,670 T1D pregnancies (4155 real-time CGM, 1515 is-CGM) and 2,455 T2D pregnancies (1140 real-time, 1315 Flash) will be reviewed.

Whilst CGM use is associated with unequivocal benefits in T1D pregnancy, it is inadequate for optimal pregnancy glucose target attainment. Hybrid closed-loop (HCL)systems providing automated glucose responsive insulin delivery are set to revolutionise the management of T1D. However, pregnancy poses formidable challenges, including more stringent glucose targets, gestational changes in insulin sensitivity and day to day variations in insulin pharmacokinetics. Therefore, HCL systems that are effective outside pregnancy, cannot guarantee clinically relevant glycaemic benefits throughout pregnancy. I will summarise the evidence from two pivotal randomised trials, suggesting that the benefits of HCL therapy during T1D pregnancy are system-specific, with only one HCL system (CamAPS FX) offering clinical benefits to a generalisable patient population, regardless of previous technology use and across all maternal HbA1c categories.

There are stark inequalities in diabetes technology access, and an urgent unmet need for high quality RCT data regarding the role of technology and of pharmacotherapy in women of reproductive years living with T2D, who now outnumber those with T1D.

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