Background: Suboptimal glycemic control is associated with maternal and neonatal morbidity and mortality in pregnancy complicated by type 1 diabetes (T1D). Prospective analysis of continuous glucose monitoring (CGM) metrics, insulin pump settings, and insulin delivery can better characterize the changes in glycemic levels and insulin use throughout pregnancy with T1D. Materials and Methods: Prescribed parameters, insulin delivery, carbohydrate intake, and CGM data for 25 pregnant women with T1D from three U.S. sites were collected. Participants enrolled before 17 weeks gestation and used personal insulin pumps and study CGM. Mean daily total, basal, and bolus insulin doses (units/kg), CGM time in range (TIR: 63–140 mg/dL), and pump-entered carbohydrates were analyzed for every 2-week gestational interval. Linear mixed-effects regression models were used to evaluate changes across gestational ages compared to 12–14 weeks. Results: Basal insulin was higher during weeks 6–12 and 24–40. Daily bolus and total insulin were higher during weeks 20–40. Pump parameters were adjusted to intensify insulin therapy from 22 weeks onward. Average TIR across pregnancy was 59% ± 14%. Between 18 and 30 weeks, TIR was significantly lower, and time above range was significantly higher compared to the reference biweek. Time below target was lower between 22 and 34 weeks. Seven participants achieved >70% recommended TIR for pregnancy. Participants with maternal complications or infant neonatal intensive care unit admissions had lower TIR. Conclusion: While insulin dosing changed significantly with advancing gestation, most participants did not achieve >70% TIR. Customized anticipatory pump setting adjustments and automated systems aimed toward the designated TIR are needed to improve outcomes for this population. NCT03761615

Background: Up to one-third of people with gestational diabetes (GDM) will have persistent dysglycemia, and more than half do not complete the recommended postpartum oral glucose tolerance test (OGTT). This study assessed the use of blinded postpartum continuous glucose monitoring (CGM) to detect dysglycemia by assessing return rates, participant experience, and power to predict OGTT results. Method: Blinded CGM was placed on postpartum day 1 to 3 before discharge from the hospital and again at six weeks after pregnancy complicated by GDM and worn at home for up to 10 days. Participants mailed the CGM back and were encouraged to undergo standard of care six-week OGTT. Results: Fifty women (36 ± 6 years old; 40% non-Hispanic white, 24% non-Hispanic black, 22% Asian, 14% Hispanic; 34% Medicaid insured) were consented. First CGM was completed by 86%, second CGM was completed by 60%, and postpartum OGTT was performed by 68%. Mean first sensor glucose was 121.8 ± 14.1 mg/dL. Dysglycemia on OGTT was diagnosed in seven participants: six with impaired glucose tolerance (18%) and one with diabetes (3%). Percent time <96% in the range 70 to 180 mg/dL predicted abnormal OGTT with positive predictive value of 54% and negative predictive value of 100%. The sensitivity and specificity of CGM to predict postpartum dysglycemia were 100% and 78%, respectively. If given a choice, 94% of participants would prefer CGM over OGTT. Conclusions: Postpartum CGM is a reasonable and convenient initial postpartum screen for postpartum dysglycemia with high completion rates, sensitivity, and acceptability ratings. Percent time in range 70 to 180 mg/dL had strong predictive power for OGTT.

Hyperglycemia in hospitalized patients with coronavirus disease 2019 (COVID-19) is linked to increased morbidity and mortality. This article reports on a novel insulin titration protocol for the management of glucocorticoid-induced hyperglycemia in hospitalized patients with COVID-19. Sixty-five patients with COVID-19 and glucocorticoid-induced hyperglycemia admitted after the protocol implementation were matched 1:1 to patients admitted before the treatment protocol rollout for analysis. In a large, diverse health system, the protocol achieved reductions in hypoglycemic events without increasing hyperglycemia or insulin use.