Norbert Freinkel emphasized the need for “more aggressive therapy with exogenous insulin” during type 1 diabetes (T1D) pregnancy. Recent advances in diabetes technology, continuous glucose monitoring (CGM), and hybrid closed-loop (HCL) insulin delivery systems allow us to revisit Freinkel’s observations from a contemporary perspective. The Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT) led to international recommendations that CGM be offered to all pregnant women with T1D to help them meet their pregnancy glucose targets and improve neonatal outcomes. However, despite CGM use, only 35% of trial participants reached the pregnancy glucose targets by 35 weeks’ gestation, which is too late for optimal obstetric and neonatal outcomes. The constant vigilance to CGM data and insulin dose adjustment, with perpetual worry about the impact of hyperglycemia on the developing fetal structures, leave many pregnant women feeling overwhelmed. HCL systems that can adapt to marked gestational changes in insulin sensitivity and pharmacokinetics may help to bridge the gap between the nonpregnant time in range glycemic targets (70–180 mg/dL) and the substantially more stringent pregnancy-specific targets (TIRp) (63–140 mg/dL) required for optimal obstetric and neonatal outcomes. Use of HCL (CamAPS FX system) was associated with a 10.5% higher TIRp, 10.2% less hyperglycemia, and 12.3% higher overnight TIRp. Clinical benefits were accompanied by 3.7 kg (8 lb) less gestational weight gain and consistently achieved across a representative patient population of insulin pump or injection users, across trial sites, and across maternal HbA1c categories. Working collaboratively, women, HCL technology, and health care teams achieved improved glycemia with less worry, less work, and more positive pregnancy experiences.

中文翻译：

---

糖尿病妊娠技术路线图：2023 年 Norbert Freinkel 奖讲座

Norbert Freinkel 强调 1 型糖尿病 (T1D) 妊娠期间需要“使用外源性胰岛素进行更积极的治疗”。糖尿病技术、连续血糖监测 (CGM) 和混合闭环 (HCL) 胰岛素输送系统的最新进展使我们能够从当代的角度重新审视 Freinkel 的观察结果。妊娠期 1 型糖尿病女性连续血糖监测试验 (CONCEPTT) 提出了国际建议，即向所有 1 型糖尿病孕妇提供 CGM，以帮助她们达到妊娠期血糖目标并改善新生儿结局。然而，尽管使用了 CGM，但只有 35% 的试验参与者在妊娠 35 周时达到妊娠血糖目标，这对于最佳产科和新生儿结局来说为时已晚。对 CGM 数据和胰岛素剂量调整的持续警惕，以及对高血糖对发育中胎儿结构的影响的永久担忧，让许多孕妇感到不知所措。能够适应胰岛素敏感性和药代动力学显着妊娠变化的 HCL 系统可能有助于弥合非妊娠时间范围内的血糖目标 (70–180 mg/dL) 与更为严格的妊娠特异性目标 (TIRp) 之间的差距 (63 –140 mg/dL）是获得最佳产科和新生儿结局所需的。使用 HCL（CamAPS FX 系统）可使 TIRp 提高 10.5%，高血糖降低 10.2%，过夜 TIRp 提高 12.3%。临床获益还包括妊娠期体重增加减少 3.7 公斤（8 磅），并且在胰岛素泵或注射使用者的代表性患者群体、各个试验地点以及各个母亲 HbA1c 类别中始终如一地实现。女性、HCL 技术和医疗保健团队通力合作，改善了血糖，减少了担忧，减少了工作量，并获得了更积极的怀孕体验。