Controlling type 1 diabetes in pregnancy: a better way of giving insulin?

Our scientists are developing an automated way of giving pregnant women with type 1 diabetes the exact amount of insulin they need, and will investigate whether this can help to improve pregnancy outcomes and the health of the mother during pregnancy.

Start: September 2018

End: August 2021

Type 1 diabetes can be hard to manage in pregnancy as blood glucose levels can be erratic. Although many women with type 1 diabetes have healthy pregnancies, there can be severe consequences for both mother and baby if diabetes is poorly controlled.

High blood glucose levels can lead to one in two babies being born overweight or obese and 1 in 3 babies are delivered prematurely. However, dangerously low blood glucose levels can also affect the health of the mother.

A more efficient way of giving insulin

Over the last few years, scientists have developed an automated way of giving patients the exact amount of insulin they need to control their type 1 diabetes. This is known as a closed-loop system; it consists of a continuous glucose monitor, an insulin pump and a computer program that essentially functions as an artificial pancreas.

Using real-time information from the continuous glucose monitor, the computer program adjusts the amount of insulin the patient receives. In patients who are not pregnant, this closed-loop system can help keep blood glucose levels within a healthy range.

Can we use this for pregnant women?

We want to see if it is possible to use this “artificial pancreas” to control type 1 diabetes in pregnant women. To do this, we are developing the closed-loop in pregnancy (CLIP) system. As well as a continuous glucose monitor and insulin pump, the CLIP system will include a new mobile phone app that is specific for pregnancy and automatically adjusts the insulin dose every 10–12 minutes.

We will test this system in a study of 124 women, with half using the CLIP system and half using standard insulin pens or pumps. We want to see if the CLIP system can increase the proportion of time that blood glucose levels are within a healthy range, and if it can help avoid episodes of dangerously high or low glucose levels.

If so, will it make pregnancy safer?

We also want to know whether the CLIP system can improve outcomes for both mother and baby, and we hope its use can reduce the proportion of babies that are born either too small or too large, or that need to be admitted to a Neonatal Intensive Care Unit.

We will also look at whether women who use the CLIP system have fewer severe diabetes complications, and if pregnancy loss, stillbirth and neonatal death are reduced.

Join the fight for healthy pregnancies and babies

Tommy's funds research across the UK investigating the reasons for miscarriage, stillbirth and premature birth, and fighting to make pregnancy and birth safer. We can keep you updated on ways you can support our work. If you would like to join our fight, click here.

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