A Randomized Trial of Closed-Loop Insulin Delivery Postpartum in Type 1 Diabetes

OBJECTIVE This study aimed to evaluate the efficacy of closed-loop insulin delivery postpartum. RESEARCH DESIGN AND METHODS In this open-label, randomized controlled trial, postpartum individuals with type 1 diabetes were randomized to hybrid closed-loop insulin delivery with the MiniMed 670G/770G system in automode or sensor-augmented pump therapy in the first 12-weeks postpartum followed by a continuation phase with closed-loop insulin delivery for all until 24 weeks postpartum. RESULTS Eighteen participants (mean +/- SD age 32 +/- 3.5 years, diabetes duration 22 +/- 7.3 years, and early pregnancy HbA1c 52 +/- 6.8 mmol/mol [6.9 +/- 0.9%]) completed 24 weeks of postpartum follow-up. In the randomized phase, percent time in range 70-180 mg/dL (3.9-10 mmol/L) did not differ between groups (79.2 +/- 8.7% vs. 78.2 +/- 6.0%; P = 0.41). Participants randomized to closed-loop insulin delivery spent less time <70 mg/dL (3.9 mmol/L) and <54 mg/dL (3.0 mmol/L) (1.7 +/- 0.8% vs. 5.5 +/- 3.3% [P < 0.001] and 0.3 +/- 0.2% vs. 1.1 +/- 0.9% [P = 0.008]). Time >180 mg/dL (10 mmol/L) was not different between groups (18.7 +/- 8.8% vs. 15.9 +/- 7.7%; P = 0.21). In the continuation phase, those initially randomized to sensor-augmented pump therapy had less time <70 mg/dL after initiation of closed-loop insulin delivery (5.5 +/- 3.3% vs. 3.3 +/- 2.2%; P = 0.039). The closed-loop group maintained similar glycemic metrics in both study phases. There were no episodes of diabetic ketoacidosis or severe hypoglycemia in the randomized or continuation phase in either group. CONCLUSIONS Women randomized to closed-loop insulin delivery postpartum had less hypoglycemia than those randomized to sensor-augmented pump therapy. There were no safety concerns. These findings are reassuring for use of closed-loop insulin delivery postpartum because of its potential to reduce hypoglycemia.