Use of Advanced Hybrid Closed-Loop System during Pregnancy: Strengths and Limitations of Achieving a Tight Glycemic Control

Background: Pregnant women with type 1 diabetes mellitus (T1DM) face an elevated risk of complications for both themselves and their newborns. Experts recommend strict glycemic control. The advanced hybrid closed-loop (AHCL) system, though not officially approved for pregnant T1DM patients, is promising for optimal glycemic control. Methods: We collected CGM metrics, HbA1c levels, insulin pump settings, and doses from a 33-year-old pregnant woman with 23-year history of T1DM from the 6th week of gestation to birth. She was initially on continuous insulin pump therapy with CGM and switched to the AHCL system (MiniMedTM 780G, Medtronic, Northridge, CA, USA) between weeks 13 and 14. Results: The AHCL system improved glycemic control from weeks 14 to 26, achieving international guidelines with TIR = 72%, TAR = 24%, TBR = 4%. At week 30, TIR was 66%, TAR 31%. By altering diet and adding ‘fake carbohydrates’, she maintained TIR ≥ 70%, TBR ≤ 4%, TAR ≤ 26% from week 34 to birth. A healthy 4 kg, 53 cm baby boy was born at week 38. Conclusions: The use of the AHCL system holds significant promise for improving glycemic control in pregnancy. Optimal glycemic control with MiniMedTM 780G in pregnancy requires accurate carbohydrate counting, specific timing of insulin doses in relation to meal consumption and dietary choices that reduce the glycemic load of meals continue to be crucial factors in achieving optimal glycemic control during pregnancy using the MiniMedTM 780G system. Further research and clinical studies are needed to explore the full potential of these advanced systems in managing T1DM during pregnancy and optimizing maternal and neonatal outcomes.