The ongoing advances in diabetes technology in insulin delivery as well as in glucose monitoring are facilitating glycaemic management as well as improving quality of life and reducing the burden of living with diabetes. However management of women with type 1 diabetes in pregnancy remains challenging. The need for targeting tight glycaemic control, the ever changing insulin requirements and additional issues when morning sickness or gastroparesis are present requires alterations in the usage of technology during pregnancy
Insulin pump therapy may assist in achieving better glycaemic control, reduce glycaemic excursions and improve quality of life. It is not the preferred mode of insulin delivery for all though and requires appropriate training and active engagement of the woman with diabetes for both optimal and safe usage. In addition it is not affordable for many. It also carries risk for ketoacidosis which is a significant concern in pregnancy. It has not clearly been shown to lead to better pregnancy outcomes. Predictive insulin suspends and auto-mode are additional issues now requiring consideration.
Continuous glucose monitoring (CGM) in conjunction with fingerprick glucose testing has been shown in the CONCEPTT study to lead to better pregnancy outcomes compared to fingerprick testing alone. The CONCEPTT data led to the Commonwealth Government providing fully subsidised access to CGM for women with type 1 diabetes starting pre-pregnancy and continuing till 3 months after due delivery date.
All forms of diabetes technology require appropriate patient education and support. Diabetes technology is very time demanding for diabetes health professionals particularly during pregnancy when contact /review is required mostly weekly for assessment and decisions on glycaemic management.