Sensor-Derived Glycemic Metrics in Women with Type 1 Diabetes Using Insulin Degludec Versus Other Basal Insulin...

To explore sensor-derived glycemic metrics during pregnancy in women with type 1 diabetes using insulin degludec or other basal insulin analogs.

A post hoc analysis of 87 pregnant women with type 1 diabetes using intermittently scanned continuous glucose monitoring and multiple daily injections, including basal insulin analogs in the CopenFast trial. Glycemic metrics, including mean sensor glucose, time in range (TIRp, 3.5-7.8 mmol/L), and time below range in pregnancy (TBRp, <3.5 mmol/L), were assessed from periconception to 37 completed weeks.

In total, 58 women used degludec and 29 women used other basal insulin analogs. At baseline (median = 9.5 gestational weeks, interquartile range = 9.0-11.0), hemoglobin A1c was 50 ± 9 versus 46 ± 6 (p = 0.04) mmol/mol, and diabetes duration was 16 (10-21) versus 9 (4-19) years (p = 0.35). The use of faster-acting insulin aspart and insulin aspart was equally distributed in the two groups. Glycemic metrics were comparable throughout pregnancy for 24 hours in both groups. During nighttime, mean sensor glucose was higher and TIRp was lower in women using degludec compared with women using other basal insulin analogs, while TBRp was above treatment targets in both groups throughout pregnancy. Severe hypoglycemia occurred in 1 (2%) versus 5 (17%) (p = 0.01). Birthweight standard deviation score was 1.5 ± 1.2 versus 0.8 ± 1.1 (p = 0.01).

In this post hoc analysis, pregnant women with type 1 diabetes using degludec achieved lower nighttime TIRp, experienced less severe hypoglycemia, and delivered infants who were heavier and thereby had less appropriate size compared with women using other basal insulin analogs.