Time in range and mean glucose cut-off points for reduction of fetal outcomes in pregnant women with type 1 diabetes using automated insulin delivery systems

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dc.contributor.authorMedina, Ana Maria Gomez
dc.contributor.authorCarrillo, Diana Cristina Henao
dc.contributor.authorMacias, Maria Natalia Serrano
dc.contributor.authorChavez, Maria Juliana Soto
dc.contributor.authorGomez, Maria Alejandra Robledo
dc.contributor.authorParra, Dario
dc.contributor.authorGonzalez, Javier Alberto Gomez
dc.contributor.authorGrassi, Bruno
dc.contributor.authorImitola, Angelica
dc.contributor.authorCob, Alejandro
dc.contributor.authorRondon, Martin
dc.contributor.authorGarcia, Maira
dc.contributor.authorVelandia, Oscar Mauricio Munoz
dc.date.accessioned2025-01-20T16:04:37Z
dc.date.available2025-01-20T16:04:37Z
dc.date.issued2024
dc.description.abstractAim: In pregnant women with Type 1 Diabetes (T1D), achieving a lower recommended time in range (TIRp,63-140 mg/dl) could have an impact on fetal outcomes. To determine the TIRp and mean glucose cut-off point associated with better fetal outcomes in pregnant women using automated insulin delivery (AID) systems. Methods: A prospective cohort of pregnant women with T1D, using AID systems and followed-up in Latin America was analyzed. Optimal TIRp and mean glucose cut-off points for predicting large for gestational age (LGA) were determined using the Liu method. Fetal outcomes were evaluated for the identified cut-off point and the one recommended by guidelines (TIRp > 70 %). Results: Sixty-two patients were included (mean age 31.9 +/- 5.9 years, HbA1c 7.57 %+/- 1.29 %, TIRp 59.8 %+/- 14.6 %). 27.5 % on advanced hybrid closed loop systems (AHCL). LGA (50 vs 17.9 %,p = 0.010) and hyperbilirubinemia (45 % vs 11.8 %,p = 0.016) were more common in patients with TIRp < 59.1 %. Optimal cut-off of TIRp in the second trimester for predicting LGA was < 59.1 % (sensitivity 75 %, specificity 61 %) with an AUC of 0.68(CI 0.48-0.88). Optimal cut-off for mean glucose was 133 mg/dL (sensitivity 69 %, specificity 70 %) with an AUC of 0.70(CI 0.51-0.88) in the same trimester. Better metabolic control during the third trimester was seen in the AHCL users compared to other devices. Conclusions: TIRp > 59.1 % and mean glucose < 133 mg/dl in the second trimester, is associated with lower fetal outcomes of large for gestational age. One of the strategies that would improve TIRp is the early use of AHCL systems. Further studies are needed before a strong recommendation can be made.
dc.fuente.origenWOS
dc.identifier.doi10.1016/j.diabres.2024.111902
dc.identifier.eissn1872-8227
dc.identifier.issn0168-8227
dc.identifier.urihttps://doi.org/10.1016/j.diabres.2024.111902
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/89820
dc.identifier.wosidWOS:001349504800001
dc.language.isoen
dc.revistaDiabetes research and clinical practice
dc.rightsacceso restringido
dc.subjectTime in range
dc.subjectAutomated insulin delivery system
dc.subjectAdverse maternofetal outcomes
dc.subjectType 1 diabetes
dc.subjectPregnancy
dc.titleTime in range and mean glucose cut-off points for reduction of fetal outcomes in pregnant women with type 1 diabetes using automated insulin delivery systems
dc.typeartículo
dc.volumen217
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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