A Diabetes Care perspective sets out a gap many clinicians manage without naming. Automated insulin delivery (AID) is now the recommended way to deliver insulin in type 1 diabetes, yet most systems approved in the US are not labelled for pregnancy, and their algorithms aim for targets higher than those recommended in pregnancy.
The authors point to a specific mechanism: many systems cut back insulin delivery when sensor glucose is within the range that pregnancy targets. Pregnant women have also been routinely excluded from the device trials, so there are few data to guide use.
The piece calls for pregnant participants in AID trials, pregnancy-specific algorithms and real-world studies of current devices. It is an opinion piece, not new trial data, but it is a useful prompt to look at how a pregnant patient's system is actually configured.
- Ask every pregnant patient with type 1 diabetes which AID system she uses and what its lowest settable target is.
- Check whether her device is labelled for use in pregnancy and say so when counselling.
- Review CGM time in the pregnancy target range, not only overall time in range.
- Involve the diabetes technology team early when targets cannot be reached on the algorithm's own settings.
Why it matters
A device recommended as standard care may be quietly working against pregnancy targets.
Don't overread it
This is a call to action from experts, not trial evidence that any device harms pregnancy outcomes.
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