Treatment of Type 1 Diabetes Mellitus During Pregnancy Using an Insulin Pump with an Advanced Hybrid Closed-Loop System

Pregnancy in women with type 1 diabetes mellitus (T1DM) is associated with a high risk of both perinatal and maternal complications, including preeclampsia, preterm birth, macrosomia, and neonatal hypoglycaemia. Achieving optimal glycaemic control is key to reducing the risk of these complications. In addition to basal-bolus insulin therapy (BBT), treatment options currently include insulin pumps (CSII) and continuous glucose monitoring (CGM), with newer technologies such as automated insulin delivery (AID) systems and advanced hybrid closed-loop (AHCL) systems showing promise. Clinical studies—including CONCEPTT, AiDAPT, and CRISTAL—suggest that AID and AHCL systems can improve glycaemic control, increase time in range (TIR), reduce the risk of hypoglycaemia, and improve perinatal outcomes, including a reduced incidence of macrosomia and neonatal hypoglycaemia. New guidelines (NICE 2023) recommend the use of AHCL systems during pregnancy. Although achieving optimal glycaemic control remains challenging, technological advancements bring hope for improved outcomes for both mothers with T1DM and their newborns.