A multicenter international trial led by researchers from the University of Calgary indicates that automated insulin delivery (AID) technology can improve glucose control during pregnancy for people with Type 1 diabetes.
The study, conducted across 14 sites in Canada and Australia, evaluated a hybrid closed-loop (HCL) system that adjusts insulin delivery in real time based on current and predicted glucose levels, in comparison with standard insulin injections or non-automated insulin pumps, all paired with continuous glucose monitoring.
What is AID and why it matters
AID systems, sometimes described as a “synthetic pancreas,” automate insulin dosing through a pump guided by continuous glucose data. The goal is to maintain glucose within a narrow target range, a challenge that intensifies during pregnancy due to changing insulin needs. For pregnant individuals with Type 1 diabetes, keeping glucose levels within a healthy range is crucial for both maternal health and fetal development.
Key findings
The trial demonstrated a meaningful improvement in time spent in the target glucose range for those using the AID system. Specifically, participants achieved an average of about three additional hours per day in the desired glucose range compared with those receiving standard delivery methods. This improvement aligns with prior evidence suggesting that even small increases in time spent within the target range during pregnancy can be associated with fewer newborn complications.
Beyond overall glucose time in range, the study noted reductions in both hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose), contributing to a more stable glucose profile throughout pregnancy. Importantly, the positive effects of AID were observed consistently across all participating sites, indicating broad applicability within diverse clinical settings.
Clinical implications
Dr. Lois Donovan, an endocrinologist at Foothills Medical Centre and a co-principal investigator, emphasized that maintaining stable glucose during pregnancy supports better outcomes for both mother and baby. Dr. Denice Feig, co-principal investigator from the Lunenfeld-Tanenbaum Research Institute and University of Toronto, noted that pregnancy can alter insulin requirements rapidly, and many existing devices were not optimized for these narrow targets or rapid shifts. The study’s results suggest AID can help bridge that gap.
The specific device used in the trial was the Tandem t:slim X2 insulin pump with Control-IQ technology, a commercially available system designed to automate insulin delivery within a closed-loop framework. While AID has shown benefits in nonpregnant populations, this study provides important evidence supporting its use during pregnancy.
Practical considerations
For clinicians and patients considering AID during pregnancy, the findings underscore the potential for improved glucose control and possibly better pregnancy outcomes. As with all diabetes technologies, successful use depends on proper education, ongoing clinical support, and access to continuous glucose monitoring. Clinicians should weigh costs, device availability, and individual pregnancy needs when discussing AID options.
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