Advancing Maternal Care: Automated Insulin Systems in Type 1 Diabetes

Automated closed-loop insulin delivery increased time in pregnancy glucose targets by roughly three hours per day in a randomized multicenter trial—a clinically meaningful improvement for pregnant women with Type 1 diabetes.

Compared with conventional insulin pump therapy or multiple daily injections, hybrid closed-loop automation reduced glucose variability and lowered time spent outside tight pregnancy targets. Continuous glucose monitoring enabled detection of these differences; findings were reported across 14 international sites enrolling pregnant women with Type 1 diabetes.

The randomized controlled multicenter trial enrolled several hundred pregnant women with pre-existing Type 1 diabetes across 14 sites in Canada and Australia and compared hybrid closed-loop therapy with standard insulin delivery plus CGM. The primary endpoint was time-in-range measured by continuous glucose monitoring, a clinically meaningful metric associated with neonatal outcomes.

Participants randomized to the closed-loop intervention spent about three additional hours per day in time-in-range (≈12% absolute increase over 24 hours), with effects described as consistent across gestation.

Maternal and neonatal safety signals were acceptable: CGM integration enabled closed-loop function, device-related adverse events were uncommon, and neonatal monitoring reflected fewer early hypoglycemia events. Implementation barriers include device training needs, access and equity challenges, and clinic workflow integration. Operational readiness—training pathways, secured device access, and defined monitoring protocols—will be necessary before broader rollout.