Dietary Patterns of Insulin Pump and Multiple Daily Injection Users During Type 1 Diabetes Pregnancy
Authors: Sandra L. Neoh, Jennifer M. Yamamoto, Denice S. Feig, Helen R. Murphy, Helen Murphy, Jeannie Grisoni, Carolyn Byrne, Sandra Neoh, Katy Davenport, Lois Donovan, Claire Gougeon, Carolyn Oldford, Catherine Young, Stephanie Amiel, Katharine Hunt, Louisa Green, Helen Rogers, Benedetta Rossi, Denice Feig, Barbara Cleave, Michelle Strom, Rosa Corcoy, Alberto de Leiva, Juan María Adelantado, Ana Isabel Chico, Diana Tundidor, Erin Keely, Janine Malcolm, Kathy Henry, Damian Morris, Gerry Rayman, Duncan Fowler, Susan Mitchell, Josephine Rosier, Rosemary Temple, Jeremy Turner, Gioia Canciani, Niranjala Hewapathirana, Leanne Piper, Ruth McManus, Anne Kudirka, Margaret Watson, Matteo Bonomo, Basilio Pintaudi, Federico Bertuzzi, Giuseppina Daniela Corica, Elena Mion, Julia Lowe, Ilana Halperin, Anna Rogowsky, Sapida Adib, Robert Lindsay, David Carty, Isobel Crawford, Fiona Mackenzie, Therese McSorley, John Booth, Natalia McInnes, Ada Smith, Irene Stanton, Tracy Tazzeo, John Weisnagel, Peter Mansell, Nia Jones, Gayna Babington, Dawn Spick, Malcolm MacDougall, Sharon Chilton, Terri Cutts, Michelle Perkins, Eleanor Scott, Del Endersby, Anna Dover, Frances Dougherty, Susan Johnston, Simon Heller, Peter Novodorsky, Sue Hudson, Chloe Nisbet, Thomas Ransom, Jill Coolen, Darlene Baxendale, Richard Holt, Jane Forbes, Nicki Martin, Fiona Walbridge, Fidelma Dunne, Sharon Conway, Aoife Egan, Collette Kirwin, Michael Maresh, Gretta Kearney, Juliet Morris, Susan Quinn, Rudy Bilous, Rasha Mukhtar, Ariane Godbout, Sylvie Daigle, Alexandra Lubina Solomon, Margaret Jackson, Emma Paul, Julie Taylor, Robyn Houlden, Adriana Breen, Anita Banerjee, Anna Brackenridge, Annette Briley, Anna Reid, Claire Singh, Jill Newstead-Angel, Janet Baxter, Sam Philip, Martyna Chlost, Lynne Murray, Kristin Castorino, Lois Jovanovic, Donna Frase, Sonya Mergler, Kathryn Mangoff, Johanna Sanchez, Gail Klein, Katrina Ruedy, Craig Kollman, Olivia Lou, Marlon Pragnell
Journal: Diabetes Care (2019)

Insulin pump therapy offers theoretical advantages over multiple daily injections (MDI) for fine-tuning insulin dose adjustment. However, evidence regarding the effectiveness of pump compared with MDI on glycemic control during pregnancy is conflicting. The Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT) was a randomized trial of continuous glucose monitoring (CGM) before and during pregnancy (1). A secondary analysis found that pregnant women using pumps had suboptimal midgestation glycemic control compared with women using MDI (2). CGM measures demonstrated comparable time in range (TIR) 63–140 mg/dL at 12 and 34 weeks but 5% lower TIR in pump users at 24 weeks (48% vs. 53%), meaning that pump users spent, on average, 1 h 15 min per day less time in the glucose target range.

There are several potential explanations for this, including baseline differences in women using pump or MDI, differences in insulin dose adjustment, and differences in dietary intake. Women using pumps have more dietary flexibility with no additional injections required for snacks. Through the use of prospectively collected dietary data from U.K. and Irish CONCEPTT participants, our objective was to examine the dietary patterns of women using insulin pumps and MDI during pregnancy.

Details of the main CONCEPTT, pump versus MDI, and diet studies were previously published (1–3). All U.K. participants ( n = 113) were invited to participate in the CONCEPTT diet …