Psychological Impact of Diabetes Technology on Type 1 Diabetes Pregnancy

Abstract

Pregnant women with Type 1 Diabetes (T1D) experience challenges with glycemic management, planning for and transitioning into motherhood. Diabetes technology (DT) has been shown to improve glycemic control and pregnancy outcomes. The data on psychological aspects for the use of DT among women and their families during different stages of pregnancy is very sparse. This study characterized the perceived benefits and burdens of DT during T1D pre-, ongoing, and past-pregnancy journey. We surveyed 119 women with T1D from 12 countries (mean age 33.33 ± 5.26 years) as “Planning” (PP), “Attempting” (AP), “Previously” (PrP), or “Currently” (CP) pregnant. We explored the top three perceived “benefits” and “burdens” of DT (and their partners if relevant). Survey questions included: type of CGM device and insulin pump, use of hybrid closed-loop (Medtronic 670 G or Tandem X2 w/ Dexcom G6) or DIY system, insurance coverage, monthly out of pocket costs, breastfeeding. Results: 67 women in PrP group, 38 in CP group, and 7 in both PP and AP groups. A majority used CGM or insulin pump prior to pregnancy (n = 90 for CGM, n = 100 for pump). 11 women did not use any DT prior to pregnancy (n = 1 in CP group, n = 10 in PrP group). Five initiated DT during the first trimester, one during the second trimester, and five did not use any DT. Three women in CP group initiated CGM during the first trimester. Out of 12 women not using CGM in PP group, 7/12 initiated during pregnancy (n = 1 for 14-day Libre, n = 5 for Dexcom G5/6, n = 1 for Guardian 3). Overall these women, and their partners, perceived more benefits than burdens. Top three benefits of DT were “overall improved BS control,” improved confidence in DM control,” and “improved ease of administering insulin” (n = 86, 56, 55 respectively). Top three burdens were “alarms,” “problems with infusion sets,” and “glitches with sensors” (n = 52, 45, 43 respectively). Perceived benefits of DT for partners were the same except for a differing top-ranked benefit of “less worry about overnight hypoglycemia.” Burdens for partners were the same except for a differing top-ranked burden of “obsessiveness (more time thinking about BS).” CGM device usage showed: 68% for Dexcom (G4/5/6), 14.9% for Guardian 3, 9.9% for Libre (10 and 14 -day), and 7% reported no usage. Insulin pump usage showed: 52.2% for Medtronic, 15.7% for Tandem T:slim, 13% for Omnipod, 6% indicated other systems not listed, and 13% reported no usage. 26% of women have used a hybrid closed-loop system and 23% have used a DIY system. Our study is the first one to identify specific psychological benefits and stressors with the use of DT in women and their significant others internationally at various stages around pregnancy. It provides insight to clinicians on how to best counsel women and their families. Having the right expectations will help the with adaptability of DT and increase its use in order to improve pregnancy outcomes.