Advanced hybrid closed loop systems in pregnancy: a case series of women with type 1 diabetes
File(s)
Accepted version
Author(s)
Kechagias, Konstantinos
Brackenridge, Anna
Stathi, Dimitra
Rogers, Helen
Type
Journal Article
Abstract
Background: Hybrid closed loop systems (HCLS) lead to improved glycaemic outcomes without the increased burden of hypoglycemia. CamAPS is the only system licensed for use in pregnancy in Europe, however all the commercially available algorithms are currently used in clinical practice. The aim of this study is to share our experience of using HCLS during pregnancy.
Methods: This is a retrospective study. We reviewed records at two teaching hospitals from January 2018 - March 2023 and identified 42 women of whom 42.8% (n=18) were established on HCLS prior to pregnancy and 57.2% (n=24) started during pregnancy at median 12 weeks of gestation.
Results: Time in pregnancy target range (TIRp) (3.5-7.8 mmol/l) increased from 57% (44.5%- 65%) (median, IQR) at first visit to 73% (65%-82%) (p<0.001) at 34 weeks of gestation with 66% achieving ≥ 70% at 34 weeks. Time below range (TBR) glucose did not change significantly. There was no significant difference in TIRp at 8 or 34 weeks between those started on HCLS before versus during pregnancy. TBR at first visit was lower in those established on HCLS pre-pregnancy versus those started in pregnancy (p: 0.04) with no difference between groups at 34 weeks. There were no admissions for diabetic ketoacidosis (DKA) or severe hypoglycemia. Eleven infants (26.8%) had birthweight over 90th percentile and neonatal hypoglycemia was recorded in 9 cases (22%).
Conclusions: In our cohort, HCLS in pregnancy was effective, with 66% achieving ≥70% TIRp, and appears to be safe with low TBR and no episodes of DKA.
Methods: This is a retrospective study. We reviewed records at two teaching hospitals from January 2018 - March 2023 and identified 42 women of whom 42.8% (n=18) were established on HCLS prior to pregnancy and 57.2% (n=24) started during pregnancy at median 12 weeks of gestation.
Results: Time in pregnancy target range (TIRp) (3.5-7.8 mmol/l) increased from 57% (44.5%- 65%) (median, IQR) at first visit to 73% (65%-82%) (p<0.001) at 34 weeks of gestation with 66% achieving ≥ 70% at 34 weeks. Time below range (TBR) glucose did not change significantly. There was no significant difference in TIRp at 8 or 34 weeks between those started on HCLS before versus during pregnancy. TBR at first visit was lower in those established on HCLS pre-pregnancy versus those started in pregnancy (p: 0.04) with no difference between groups at 34 weeks. There were no admissions for diabetic ketoacidosis (DKA) or severe hypoglycemia. Eleven infants (26.8%) had birthweight over 90th percentile and neonatal hypoglycemia was recorded in 9 cases (22%).
Conclusions: In our cohort, HCLS in pregnancy was effective, with 66% achieving ≥70% TIRp, and appears to be safe with low TBR and no episodes of DKA.
Date Issued
2026-01-01
Date Acceptance
2026-03-04
Citation
Endocrinology, Diabetes & Metabolism, 2026, 28 (1), pp.324-336
ISSN
2398-9238
Publisher
Wiley
Start Page
324
End Page
336
Journal / Book Title
Endocrinology, Diabetes & Metabolism
Volume
28
Issue
1
Copyright Statement
Copyright © 2026 Copyright Owner. This is the author’s accepted manuscript made available under a CC-BY licence in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy)
License URL
Publication Status
Published