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Pham DQ, Thorsell A, Castorino K, Cobb B. A review of CONCEPTT study findings including subanalyses in pregnant women using continuous glucose monitoring with type 1 diabetes and their offspring. Endocr Connect 2024; 13:e230407. [PMID: 38010170 PMCID: PMC10831538 DOI: 10.1530/ec-23-0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/27/2023] [Indexed: 11/29/2023]
Abstract
The main objective of this article is to provide a comprehensive review of continuous glucose monitor (CGM) use in pregnant women with type 1 diabetes (T1D) from the CONCEPTT study including subanalyses. Literature search was accessed through MEDLINE (1966-September 2023) using the key terms: CONCEPTT, pregnancy, women, T1D, and CGM with limitations set to distinguish human subjects written in English. A total of 17 publications including one main clinical trial and 15 subanalyses have been published to date regarding the use of CGM in pregnant women with T1D which were conducted by a research group identified as the CONCEPTT Collaborative Group. While advances in maternal care have resulted in safer pregnancy for both the mother and child, women with preexisting T1D and pregnancy still experience higher rates of complications both in the short and long term. The use of CGM in pregnancy has not been studied extensively until more recently. The CONCEPTT clinical trial was a landmark study that involved several subanalyses. The main trial proved that CGM use in T1D pregnancy resulted in less hyperglycemia in the third trimester, reduced large for gestational age (LGA, >90th percentile), reduced neonatal intensive care unit admissions lasting longer than 24 h, and reduced neonatal hypoglycemia. Although subanalyses showed a variety of results including 'inconclusive' due to lack of prespecification, it is believed that CGM in T1D during pregnancy is to be recommended and used for overall improved outcomes.
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Affiliation(s)
- David Q Pham
- Western University of Health Sciences, College of Pharmacy, Pomona, California, USA
- Mary & Dick Allen Diabetes Center at Hoag Hospital, Newport Beach, California, USA
| | - Ashley Thorsell
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | | | - Brandon Cobb
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
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Helman S, James-Todd TM, Wang Z, Bellavia A, Wyckoff JA, Serdy S, Halprin E, O'Brien K, Takoudes T, Gupta M, McElrath TF, Brown FM. Time trends in pregnancy-related outcomes among women with type 1 diabetes mellitus, 2004-2017. J Perinatol 2020; 40:1145-1153. [PMID: 32488037 PMCID: PMC7375951 DOI: 10.1038/s41372-020-0698-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/15/2020] [Accepted: 05/19/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine time trends in US pregnant women with type 1 diabetes mellitus for maternal characteristics and pregnancy outcomes. STUDY DESIGN We abstracted clinical data from the medical records of 700 pregnant women from 2004 to 2017. For each time period, means and percentages were calculated. P values for trend were calculated using linear and logistic regression. RESULTS HbA1c in each trimester was unchanged across the analysis period. The prevalence of nephropathy decreased from 4.8% to 0% (P = 0.002). Excessive gestational weight gain increased (P = 0.01). Gestation length also increased (P = 0.01), as did vaginal deliveries (P = 0.03). There were no change in birthweight over time (P = 0.07) and the percentage of neonates with macrosomia and large for gestational age (LGA) neonates also remained unchanged. CONCLUSION Obstetric guideline changes may have improved gestation length and mode of delivery; however, other outcomes need more attention, including excessive gestational weight gain, macrosomia, and LGA.
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Affiliation(s)
| | - Tamarra M James-Todd
- Department of Environmental health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zifan Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrea Bellavia
- Department of Environmental health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Karen O'Brien
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Hospital, Boston, MA, USA
| | - Tamara Takoudes
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Hospital, Boston, MA, USA
| | - Munish Gupta
- Department of Neonatology, Beth Israel Deaconess Hospital, Boston, MA, USA
| | - Thomas F McElrath
- Division of Maternal Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Farrington C, Stewart Z, Hovorka R, Murphy H. Women's Experiences of Day-and-Night Closed-Loop Insulin Delivery During Type 1 Diabetes Pregnancy. J Diabetes Sci Technol 2018; 12:1125-1131. [PMID: 30288999 PMCID: PMC6232744 DOI: 10.1177/1932296818800065] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIMS Closed-loop insulin delivery has the potential to improve day-to-day glucose control in type 1 diabetes pregnancy. However, the psychosocial impact of day-and-night usage of automated closed-loop systems during pregnancy is unknown. Our aim was to explore women's experiences and relationships between technology experience and levels of trust in closed-loop therapy. METHODS We recruited 16 pregnant women with type 1 diabetes to a randomized crossover trial of sensor-augmented pump therapy compared to automated closed-loop therapy. We conducted semistructured qualitative interviews at baseline and follow-up. Findings from follow-up interviews are reported here. RESULTS Women described benefits and burdens of closed-loop systems during pregnancy. Feelings of improved glucose control, excitement and peace of mind were counterbalanced by concerns about technical glitches, CGM inaccuracy, and the burden of maintenance requirements. Women expressed varied but mostly high levels of trust in closed-loop therapy. CONCLUSIONS Women displayed complex psychosocial responses to day-and-night closed-loop therapy in pregnancy. Clinicians should consider closed-loop therapy not just in terms of its potential impact on biomedical outcomes but also in terms of its impact on users' lives.
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Affiliation(s)
| | - Zoe Stewart
- Wellcome Trust–Medical Research Council
Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Department of Obstetrics and
Gynaecology, University of Cambridge, Cambridge, UK
| | - Roman Hovorka
- Wellcome Trust–Medical Research Council
Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Helen Murphy
- Wellcome Trust–Medical Research Council
Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Norwich Medical School, University of
East Anglia, Norwich, UK
- Helen Murphy, MD, Norwich Medical School,
University of East Anglia, Floor 2 Bob Champion Research and Education Building,
Norwich NR4 7UQ, UK.
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Murphy HR. Intensive Glycemic Treatment During Type 1 Diabetes Pregnancy: A Story of (Mostly) Sweet Success! Diabetes Care 2018; 41:1563-1571. [PMID: 29936423 DOI: 10.2337/dci18-0001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/12/2018] [Indexed: 02/03/2023]
Abstract
Studies from Scotland and Canada confirm large increases in the incidence of pregnancies complicated by pregestational type 1 diabetes (T1D). With this increased antenatal workload comes more specialization and staff expertise, which may be important as diabetes technology use increases. While euglycemia remains elusive and obstetrical intervention (earlier delivery, increased operative deliveries) is increasing, there have been some notable successes in the past 5-10 years. These include a decline in the rates of congenital anomaly (Canada) and stillbirths (U.K.) and substantial reductions in both maternal hypoglycemia (both moderate and severe) across many countries. However, pregnant women with T1D still spend ∼30-45% of the time (8-11 h/day) hyperglycemic during the second and third trimesters. The duration of maternal hyperglycemia appears unchanged in routine clinical care over the past decade. This ongoing fetal exposure to maternal hyperglycemia likely explains the persistent rates of large for gestational age (LGA), neonatal hypoglycemia, and neonatal intensive care unit (NICU) admissions in T1D offspring. The Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT) found that pregnant women using real-time continuous glucose monitoring (CGM) spent 5% less time (1.2 h/day) hyperglycemic during the third trimester, with clinically relevant reductions in LGA, neonatal hypoglycemia, and NICU admissions. This article will review the progress in our understanding of the intensive glycemic treatment of T1D pregnancy, focusing in particular on the recent technological advances in CGM and automated insulin delivery. It suggests that even with advanced diabetes technology, optimal maternal dietary intake is needed to minimize the neonatal complications attributed to postprandial hyperglycemia.
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Affiliation(s)
- Helen R Murphy
- Norwich Medical School, University of East Anglia, Norwich, U.K. .,Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, U.K. .,Department of Women & Children's Health, King's College London, London, U.K.
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