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At-home use of a pregnancy-specific Zone-MPC closed-loop system for pregnancies complicated by type 1 diabetes: a single arm, observational multicenter study

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posted on 2023-05-17, 21:02 authored by Carol J. Levy, Yogish C. Kudva, Basak Ozaslan, Kristin Castorino, Grenye O’Malley, Ravinder Jeet Kaur, Camilla M. Levister, Mei Mei Church, Donna Desjardins, Shelly McCrady-Spitzer, Selassie Ogyaadu, Mari Charisse Trinidad, Corey Reid, Shafaq Rizvi, Sunil Deshpande, Isabella Zaniletti, Walter K. Kremers, Jordan E. Pinsker, Francis J. Doyle III, Eyal Dassau, the LOIS-P Diabetes and Pregnancy Consortium

  

OBJECTIVE: There are no commercially available hybrid closed-loop insulin delivery systems customized to achieve pregnancy-specific glucose targets in the United States. This study aimed to evaluate the feasibility and performance of at-home use of a zone model predictive controller based closed-loop insulin delivery system customized for pregnancies complicated by type 1 diabetes (CLC-P).

RESEARCH DESIGN AND Methods: Pregnant women with type 1 diabetes using insulin pumps were enrolled in the second or early third trimester. After study sensor wear collecting run-in data on personal pump therapy and two days of supervised training, participants used CLC-P targeting 80-110 mg/dL during the day and 80-100 mg/dL overnight running on an unlocked smartphone at home. Meals and activities were unrestricted throughout the trial. The primary outcome was the continuous glucose monitoring percentage of time in the target range 63-140 mg/dL versus run-in.

Results: Ten participants (HbA1c 5.8±0.6%) used the system from mean gestational age of 23.7±3.5 weeks. Mean percentage time in range increased 14.1 percentage points, equivalent to 3.4 hours per day, compared to run-in (run-in: 64.5±16.3% versus CLC-P: 78.6±9.2%, P=0.002). During CLC-P use, there was significant decrease in both time over 140 mg/dL (P=0.033) and the hypoglycemic ranges of less than 63 mg/dL and 54 mg/dL (P=0.037 for both). Nine participants exceeded consensus goals of above 70% time in range during CLC-P use. 

ConclusionS: The results show that the extended use of CLC-P at home until delivery is feasible. Larger, randomized studies are indicated to further evaluate system efficacy and pregnancy outcomes.

Funding

Financial support for this study was provided by the National Institutes of Health (R01DK120358). Product support was provided by Dexcom, Inc (AP-2020-014). Additional financial support was provided by Helmsley Charitable Trust. REDCap data management was supported by the Research Computing Facility grant (UL1TR002377).

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