902-P: Patient Experience and Clinical Outcomes in Pregnant Patients with Type 1 Diabetes Using Open-Source Automated Insulin Dosing Systems

Type 1 diabetes (T1D) in pregnancy is associated with increased obstetrical and neonatal complications; thus, stringent glycemic targets are imperative. While commercial automated insulin dosing (AID) systems represent an important development in management of T1D, a limitation is that the glycemic targets are not adjustable for pregnancy. Before commercial AID, a community of people with T1D combined CGM sensors, insulin pumps and open-source code, developing open-source automated insulin delivery systems (OSAIDS). Given customizable glycemic targets, OSAIDS may fill an important clinical gap in pregnancy. We included participants ≥18 years old with T1D who had at least one pregnancy using OSAIDS. Of 37 completed surveys, motivations for using OSAIDS included commercial AID targets being too high for pregnancy (78%), increased ownership over diabetes (53%) and transparency (44%). The INsulin Dosing Systems: Perceptions, Ideas, Reflections and Expectations (INSPIRE) questionnaire showed that 100% strongly agreed or agreed with: helped in pregnancy (89% strongly agree), better quality of life (94% strongly agree) and better sleep (83% strongly agree). With a glycemic target of 3.5-7.8mmol/L (63-140mg/dl), 86% exceeded the time-in-range (TIR) target of ≥ 70% set by the Advanced Technologies & Treatments for Diabetes Congress. The majority (66%) had a more stringent TIR of ≥ 80%. The vast majority (97%) did not have severe hypoglycemia; 74% had time-below-range ≤ 4%. Of the 71% who experienced labor and delivery, 90% delivered at 37 weeks gestational age or greater; 90% did not have shoulder dystocia. Median birth weight was 3374g (SD 600g), 19% of newborns had macrosomia (>4000g). Neonatal hypoglycemia (<2.5mmol/L/<45mg/dl) occurred in 24% with 14% requiring NICU. OSAIDS provides excellent glycemic control, maternal quality of life and neonatal outcomes. More data is needed to validate these initial promising outcomes.