How to manage a pregnancy with myLoop
For women of childbearing age, choosing an AID system might be a matter of safety, health, and convenience. Did you know that the CamAPS FX app is indicated for pregnancy? Women who use CamAPS FX during pregnancy experienc better glucose control1and less diabetes-related anxiety2
Avoiding or minimising pronounced glucose excursions is a constant for any person living with type 1 diabetes. For those managing diabetes with multiple daily injections (MDI), such glycaemic fluctuations are often the consequence of excess correction boluses to treat hyperglycaemia, or emergency carbohydrates to “rescue” a hypo.
Reasons for choosing AID therapy
AID systems adjust insulin delivery based on individual needs of the user thanks to the input from a CGM, and the calculations performed by an algorithm. By increasing and decreasing insulin delivery, the system aims to reduce glycaemic variability and to increase the time in range.
A matter of safety: by being able to predict future glucose trends, the algorithm can suspend insulin delivery and prevent hypoglycaemia. This increased safety is especially reassuring while sleeping, exercising or during pregnancy.
A matter of health: clinical evidence continues to show the improved glycaemic management of people living with type 1 diabetes on AID systems3-6. All studied population groups, including women, reduced HbA1c and increased time in range (TIR).
A matter of convenience: “less pressure”, “more freedom”, “complete peace-of-mind”, “higher quality of life” … such phrases are used by patients and caregivers to describe how AID systems have profoundly changed their daily management of type 1 diabetes.
How AID technology can speed up pregnancy planning
The goal of a hybrid closed-loop is to help to get as close to the pre-pregnancy glucose target as it may be safely possible and, once pregnant, to tackle the challenges of managing diabetes in a way that minimises the disturbances to the glucose levels, as well as the lifestyle and wellbeing of the person living with type 1 diabetes.
Women using the CamAPS FX algorithm report easier glucose management during their pregnancies.2
Increased day-to-day variability, changes in insulin sensitivity, fear of hyperglycaemia, and huge mental burden are some of the widely documented challenges faced by women living with type 1 diabetes during pregnancy7.
myLoop helps with the above challenges by automatically adjusting insulin delivery every 8 to 12 minutes based on CGM readings and glucose predictions up to 4 hours ahead, freeing up the woman from some of the effort of tightly managing diabetes.
CamAPS FX – the app powering myLoop – was designed with the demanding pregnancy glucose targets in mind.
The AID system myLoop is made up of three key components that communicate with each other: a Continuous Glucose Monitoring (CGM) system, the YpsoPump insulin pump and the CamAPS FX app.
How myLoop supports diabetes management before, during, and after pregnancy
Personal glucose target (PGT)
The personal glucose target can be set as low as 4.4 mmol/L (80 mg/dL) in 0.1 mmol/L increments, which is a unique advantage of myLoop. A PGT within the pregnancy range (3.5–7.8 mmol/L (63–140 mg/dL))8 is key to achieving glycaemic targets during pregnancy.
Remote bolus delivery
myLoop is managed directly from the CamAPS FX smartphone app allowing to discreetly administer bolus doses. The system compensates for any potential over- or underdosing of meal boluses to keep the user in range.
Treat to target
myLoop takes care of the unexpected glucose swings typical of pregnancy. Thanks to predictive control, the algorithm calculates the insulin requirement for the next 2.5–4 hours. Furthermore, insulin delivery is adjusted every 8–12 minutes.
“Ease-off” and “Boost” modes
The “Ease-off” mode reduces insulin delivery depending on glucose levels, raises the glucose target temporarily and stops insulin delivery if the glucose level is predicted to fall below target. On the flip side, the “Boost” mode makes the algorithm more responsive increasing insulin delivery to proactively prevent or treat hyperglycemia during pregnancy.
1.Lee TTM et al.: Automated Insulin Delivery in Women with Pregnancy Complicated by Type 1 Diabetes. N Engl J Med. 2023 Oct 26;389(17):1566-1578. doi: 10.1056/NEJMoa2303911. Epub 2023 Oct 5. PMID: 37796241.
2.Lawton J et al.: Listening to Women: Experiences of Using Closed-Loop in Type 1 Diabetes Pregnancy. Diabetes Technol Ther. 2023 Dec;25(12):845-855. doi: 10.1089/dia. 2023.0323. Epub 2023 Nov 7. PMID: 37795883; PMCID: PMC10698780.
3.Tauschmann M. et al.: Closed-loop insulin delivery in suboptimally controlled type 1 diabetes: a multicentre, 12-week randomised trial. Lancet 2018;392:1321-29. doi: 10.1016/ S0140-6736(18)31947-0.
4.Ware J et al.: Randomized Trial of Closed-Loop Control in Very Young Children with Type 1 Diabetes. N Engl J Med, 2022; 386(3):209-219. doi: 10.1056/NEJMoa2111673
5.Ware J et al.: Cambridge hybrid closed-loop algorithm in children and adolescents with type 1 diabetes: a multicentre 6-month randomised controlled trial Lancet Digit Health, 2022;4(4):e245-e255. doi: 10.1016/S2589-7500(22)00020-6.
6.Boughton CK et al.: Hybrid closed-loop glucose control compared with sensor augmented pump therapy in older adults with type 1 diabetes: an open-label multicentre, multinational, randomised, crossover study. Lancet Healthy Longev. 2022; 3(3):e135-e142. DOI: 10.1016/S2666-7568(22)00005-8.
7.Oral presentation held by Tara Lee at EASD in October 2023. Session “Addressing the utmost challenge for women living with T1D: Insights from the AiDAPT AID pregnancy trial’. Presentation’s title ‘Practical Implications for clinical practice: the way forward”.
8.Battelino T et al.: Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care. 2019 Aug;42(8):1593-1603. doi: 10.2337/dci19-0028. Epub 2019 Jun 8. PMID: 31177185; PMCID: PMC6973648.
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