Enhanced Glycemic Management in Pregnancy: The Role of Closed-Loop Insulin Systems

A multicenter trial demonstrated that automated closed-loop insulin therapy substantially increased the percentage of time pregnant people with type 1 diabetes spent in the pregnancy-specific glucose range—a clinically meaningful improvement compared with standard care.

This finding shifts management away from manual titration models toward automated insulin delivery as a practical pregnancy option. Unlike prior practice, the system reduces reliance on frequent clinician-directed dose changes. Closed-loop systems continuously adjust insulin using real-time glucose signals; that operational framing has direct implications for device selection, staff training, and remote monitoring workflows.

Specifically, the randomized multicenter trial conducted across Canada and Australia enrolled pregnant people with type 1 diabetes and observed 65.4% time in the pregnancy-specific glucose range versus 50.3% with standard care across 16 to 34 weeks' gestation. The trial compared a closed-loop insulin system against standard care with continuous glucose monitoring. Shortly after system initiation the study recorded lower glycemic variability, fewer mild-to-moderate hypoglycemic events, and a substantial reduction in time above the pregnancy target.

These outcomes included exploratory secondary findings: reported improvements in maternal HbA1c at mid and late gestation and a lower observed rate of preeclampsia in the intervention arm.