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Benefits of Insulin Pump Use in Type 1 Diabetic Pregnancies

The use of insulin pumps during pregnancy could be beneficial…. 

Prior research has shown insulin pumps to be highly beneficial for managing type 1 diabetes compared to multiple daily insulin injections. With new advancements in insulin pump technology, insulin pumps are becoming a first-line choice for some patients. They may offer advantages over insulin injections alone and are convenient for most users. While insulin pumps may be superior for some patients, data from using them during pregnancy is limited.

In order to study the outcomes of insulin pumps verse insulin injections in pregnant patients with type 1 diabetes, researchers conducted a retrospective analysis to assess glycemic control and maternal-fetal outcomes. This study took place between 2006 and 2010 and analyzed 387 consecutive pregnancies of type 1 diabetics. The insulin pump group consisted of 113 pregnancies and the multi-dose insulin group of 218 women. In the insulin pump group, the mean HbA1c was 6.90  ± 0.71% compared to the multi-dose insulin group HbA1c 7.60 ± 1.38, p<0.001. These differences persisted into the 3rd trimester with insulin pump group mean HbA1c going down to 6.49 ± 0.52% and multi-dose insulin group mean of 6.81 ± 0.85%, p = 0.002. These findings are indicative of better control over blood sugars.

In both groups there was no significant difference between rates of ketoacidosis, with patients on insulin pumps having rates of ketoacidosis of 1.8% compared to 3.0% in the multi-dose insulin group. Further, even with insulin pump users having a lower HbA1c, they did not show an increased incidence of hypoglycemia (8.0% vs 7.6%, p = 0.90) nor more weight gain (16.3 ± 8.7 vs 15.2 ± 6.2 kg, p = 0.18).

The author also notes that the study had some flaws; "Women who used insulin pumps were older and had a longer duration of diabetes, more retinopathy, smoked less in pregnancy, and had more preconception care." Clearly, there are some between-group differences present that could have been better controlled for. This study also raises the question of whether insulin pumps may be beneficial in patients with gestational diabetes.

Practice Pearls
  • Pregnant, type 1 diabetics may have better control over their blood glucose by using an insulin pump compared to using insulin injections
  • Insulin-pump use may result in more favorable HbA1c levels, in pregnant type 1 diabetics, without an increased risk of hypoglycemic events or diabetic ketoacidosis
  • Insulin pumps are not for everyone and clinical judgment should always be emphasized when deciding whether to recommend a patient be on one

Kallas-koeman MM, Kong JM, Klinke JA, et al. Insulin pump use in pregnancy is associated with lower HbA1c without increasing the rate of severe hypoglycaemia or diabetic ketoacidosis in women with type 1 diabetes. Diabetologia. 2014;57(4):681-9.<http://www.ncbi.nlm.nih.gov/pubmed/24434960>