(936) Intermittent subcutaneous insulin versus insulin pump in managing patients with Type 2 Diabetes in pregnancy

To compare glycemic control in pregnant patients with Type 2 diabetes (T2DM) managed with intermittent subcutaneous insulin (ISI) therapy versus insulin pump.

Study Design:

This was a retrospective cohort study of all pregnant individuals with T2DM on insulin therapy and using a continuous glucose monitor (CGM) between 2016-2025. We compared third-trimester time in range (TIR; % time with a blood sugar between 60-140 mg/dL) and glucose level variance between insulin pump and ISI using the Wilcoxon rank-sum test. The analysis was stratified by the timing of pump initiation (first, second, or third trimester). A multivariable multinomial logistic regression model was used to assess the association between the timing of pump initiation and third-trimester TIR categories (≤50%, >50-75%, ≥75%), adjusting for first-trimester HbA1c, maternal age, BMI, ethnicity, and chronic hypertension.

Results:
Of the 125 patients in the cohort, 59 were on insulin pump therapy. The median TIR for all pump users was 70.0% (IQR 56.5–80.5) compared to 68.0% (IQR 50.2–79.5) for ISI (p=0.48). This lack of a significant difference persisted when restricting the analysis to those initiating pump therapy in the second or first trimester (p=0.48) and first trimester only (p=0.51). However, individuals who initiated pump therapy in the first trimester had a significantly lower blood glucose level variance compared to ISI (30.5 mg/dL vs. 35.5 mg/dL, p=0.04). In the multivariable analysis, the timing of insulin pump initiation was not significantly associated with better TIR categories. The only significant association with poor glycemic control (TIR ≤50%) was a higher first-trimester HbA1c (aOR 1.47, 95%CI 1.10–1.98; p=0.01).

Conclusion:

In pregnant individuals with T2DM, insulin pump use was not associated with better glycemic control compared with ISI. However, initiation of pump therapy in the first trimester was associated with significantly lower glycemic variability. Baseline glycemic status, indicated by first-trimester HbA1c, remains the most significant determinant of achieving TIR targets.