Abstract #1375428: A Case of How Diabetes Technology Improves Hypoglycemia During Pregnancy

Abstract

Demonstrate the efficacy and safety of diabetes technology in pregestational diabetes with hypoglycemic unawareness during pregnancy. We present a Case Study of a 33-year-old G1P0 with a history of Type 1 DM and hemoglobin A1c of 8.6% who presented to our diabetes clinic at 8 weeks gestation for evaluation of recurrent hypoglycemia. The patient was initially placed on Dexcom G6 Continuous Glucose Monitor (CGM) and was noted to have both frequent daily episodes of hypoglycemia and hyperglycemia outside the recommended ranges for pregnancy. At 22 weeks, the patient was transitioned to the Tandem t:slim X2 Insulin Pump with Basal IQ Technology until delivery. The Dexcom G6 CGM was able to detect hypoglycemia that was otherwise undetected during the times the patient was not self-monitoring blood glucose with a standard glucometer. Between 8 and 22-weeks gestation, CGM decreased the percentage of time in hypoglycemia (22% vs 9%). After being on the insulin pump for 7 weeks, the patient’s hypoglycemia further decreased to 5%. Furthermore, the patient’s time in range improved (44% vs 66%). Delivery occurred at 39 3/7 weeks via lower transverse cesarian section with no adverse maternal or neonatal outcomes. Use of diabetes technology in this case improved hypoglycemia that was otherwise not achievable with intensive insulin therapy management and self-monitoring of blood glucose, helping prevent poor maternal and neonatal health outcomes. Due to lack of randomized control studies on the use of diabetes technology in pregnant patients, further studies are required to identify the efficacy and safety of these devices in this patient population. Diabetes technology may be useful to Ob/Gyn and MFM physicians to aid their management of pregnancy complicated by pregestational diabetes.