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November 12, 2021
For those living with diabetes, keeping their blood sugar levels at healthy levels under normal circumstances can be a challenge. For expecting moms, hitting that narrow target can be even more difficult.
Dr. Denice Feig is a clinician scientist and Head of the Diabetes and Endocrinology in Pregnancy Program at Mount Sinai Hospital, helping safely guide women with diabetes through pregnancy and beyond. With the emergence of new technology, Dr. Feig is among the first in Canada to test whether an artificial pancreas system could also work to keep both mom and baby healthy throughout the pregnancy.
“I’m very optimistic about this new technology,” said Dr. Feig. “These artificial pancreas systems have the potential to give people with diabetes the opportunity to maintain excellent blood sugar levels and significantly lower the burden to manage the disease.”
The closed loop system is a new technology that acts like a smart insulin pump to automatically deliver insulin whenever needed. Currently, people with Type 1 diabetes have to program their pumps to give them insulin throughout the day, and studies show fewer than 20 per cent of these people are achieving their blood sugar targets.
“In pregnancy, women need to keep their blood sugars tighter than any other time in a person’s life,” Dr. Feig said. “A women’s insulin resistance changes dramatically throughout their pregnancy and they need to stay on top of that so they can have a healthy pregnancy.”
Blood sugar that is not well controlled in a pregnant woman with Type 1 diabetes could lead to problems for both the parent and the baby, including high-blood pressure, miscarriage, large birth size and a higher risk of pre-term and stillbirths.
Dr. Feig notes it can be challenging to control blood sugar levels from the outset of pregnancy, but it becomes especially challenging after the 20 week mark when hormone levels typically increase and many women experience insulin resistance and are at an increased risk of hypoglycemia.
In partnership with Dr. Lois Donovan at the University of Calgary, Dr. Feig is currently leading the first randomized trial at Mount Sinai Hospital to see if the Tandom control IQ closed loop system can be used in pregnancy. Currently, about 10 patients are enrolled in the trial, a number she hopes to double in the next six months.
“I think we’re going to learn a lot on how we can make the system work the best for pregnancy,” she says, “I’m really optimistic.”
Dr. Feig has applied to expand the trial to include up to 180 patients, and she hopes her data will one day be used to get the technology approved for use in all women during pregnancy.
“These are small steps in the journey of technology transforming diabetes care,” Dr. Feig said. “Fifty years ago, women living with diabetes were told not to get pregnant. Luckily that has changed, but we still have a ways to go.”
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