Hypoglycemia in Prospective Multicenter Study of Pregnancies with Pre-Existing Type 1 Diabetes on Sensor-Augmented Pump Therapy: The LOIS-P Study

Ravinder Jeet Kaur, Byron H. Smith, Basak Ozaslan, Jordan E. Pinsker, Mari Charisse Trinidad, Grenye O'malley, Donna Desjardins, Kristin N. Castorino, Camilla Levister, Corey Reid, Shelly Mccrady-Spitzer, Selassie J. Ogyaadu, Mei Mei Church, Molly Piper, Walter K. Kremers, Barak Rosenn, Francis J. Doyle, Eyal Dassau, Carol J. Levy, Yogish C. Kudva

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Pregnancies in type 1 diabetes are high risk, and data in the United States are limited regarding continuous glucose monitoring (CGM)-based hypoglycemia throughout pregnancy while on sensor-augmented insulin pump therapy. Materials and Methods: Pregnant women with type 1 diabetes in the LOIS-P Study (Longitudinal Observation of Insulin use and glucose Sensor metrics in Pregnant women with type 1 diabetes using continuous glucose monitors and insulin pumps) were enrolled before 17 weeks gestation at three U.S. centers and we used their personal insulin pump and a study Dexcom G6 CGM. We analyzed data of 25 pregnant women for CGM hypoglycemia based on international consensus guidelines for percentage time <63 and 54 mg/dL, hypoglycemic events and prolonged hypoglycemia events for 24-h, daytime, and overnight periods, and severe hypoglycemia (SH) episodes. Results: For a 24-h period, biweekly median percentage of time <63 mg/dL ranged from 0.8% at biweek 4-5 to 3.7% at biweek 14-15 with high variability throughout pregnancy. Median percentage of time <63 and 54 mg/dL was higher overnight than daytime (P < 0.01). Hypoglycemic events occurred throughout the pregnancy, ranged 1-4 events per 2 weeks, significantly decreased after the 20th week, and occurred predominantly during daytime (P < 0.01). For overnight period, hypoglycemia and events were more concentrated from 12 to 3 am. Seven prolonged hypoglycemia events without any associated SH occurred in four participants (16%), primarily overnight. Three participants experienced a single episode of SH. Conclusions: Our results suggest a higher overall risk of hypoglycemia throughout pregnancy during the overnight period with continued daytime risk of hypoglycemic events in pregnancies complicated by type 1 diabetes.

Original languageEnglish
Pages (from-to)544-555
Number of pages12
JournalDiabetes Technology and Therapeutics
Volume24
Issue number8
DOIs
StatePublished - 1 Aug 2022

Keywords

  • Continuous glucose monitoring
  • Hypoglycemia
  • Pregnancy
  • Prolonged hypoglycemia
  • Type 1 diabetes

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