8223 Impact Of Automated Insulin Delivery On Fear Of Hypoglycemia In Pregnant And Puerperal Women With Type 1 Diabetes: A Systematic Review And Meta-Analysis
Authors: Akabane Maria Antônia Costa Cruz , Yang Yu Marianne , Coelho Henrique , Romeiro Pedro , Hespanhol Larissa Calixto , Correa Tulio L , De Menezes Vanessa Lins 
Published: October 2024

Abstract
Disclosure: M.C. Cruz Akabane: None. M. Yang Yu: None. H. Coelho: None. P. Romeiro: None. L.C. Hespanhol: None. T.L. Correa: None. V.L. De Menezes: None.
Introduction: Patients with type 1 diabetes mellitus (T1DM) may experience a heightened fear of hypoglycemia, increasing risk of management and psychological complications. Automated Insulin delivery (AID) has shown improvements in glucose control in pregnant women with T1DM. However, its impact on patients’ concerns about hypoglycemia during gestation remains unclear. This study aimed to evaluate the impact of AID on patient-reported fear of hypoglycemia in pregnant and puerperal women. Methods: PubMed, Embase, and Cochrane Central databases were systematically searched in December 2023 for randomized controlled trials (RCTs) that compared AID to other standard therapies (ST) (sensor-augmented pump, multiple daily insulin injections, continuous glucose monitoring, and predictive low-glucose suspend) in adult pregnant or puerperal women with T1DM and reported the outcomes of (1) Hypoglycemia Fear Survey-II (HFS-II) total; (2) HFS-II worry scale; and (3) HFS-II behavior scale. A systematic review and meta-analysis of the findings were performed. Statistical analysis was performed using R version 4.3.2. Heterogeneity was examined with the Cochran Q test and I² statistics. Results: We included 5 RCTs (4 with pregnant women and 1 including puerperal women) in the final analysis, with a total of 150 participants, of whom 74 (49.34%) were on AID and 76 (50.66%) on ST. The mean age of the AID group was 32.2 (σ±0.8) years, while the ST was 31.74 (σ±0.99). The mean time since diagnosis of T1DM was 20.7 years (σ±1.98) in AID patients and 20.7 (σ±2.95) in ST. The mean gestational age at baseline in AID patients was 11.7 weeks (σ±2.19) and 11.5 weeks (σ±2.26) in ST. The follow-up period ranged between 4 and 12 weeks. The AID group had a baseline HFS-II behavior subscale mean score of 25.2 (σ±2.5), while ST had a mean of 24.9 (σ±2.61). AID patients presented a significant reduction of HFS-II behavior subscale score compared to ST (MD -1.84; 95% CI -3.29, -0.38; p= 0.01; I² = 0%). HFS-II worry scale score (MD -0.75; 95% CI -2.89, 1.38; p= 0.48; I² = 0%) and HFS-II total score (MD -0.19; 95% CI -2.72, 2.34; p= 0.77; I² = 0%) were not significantly different between groups. Conclusion: The significantly higher decrease in HFS-II behavior score while using AID suggests that this technology diminishes the fear of hypoglycemia, possibly enhancing pregnancy and puerperium behavior patterns in patients with T1DM. Nevertheless, there was no significant difference in improvement in the HFS-II total or worry subscale. AID seems to decrease the psychological burden of treatment, potentially improving patients’ quality of life and adherence to management plans. Keywords: Type 1 Diabetes, Hypoglycemia, Pregnancy
Presentation: 6/2/2024