{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T18:06:50Z","timestamp":1776103610478,"version":"3.50.1"},"reference-count":26,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Pregnant women with type 1 diabetes mellitus (T1DM) face an elevated risk of complications for both themselves and their newborns. Experts recommend strict glycemic control. The advanced hybrid closed-loop (AHCL) system, though not officially approved for pregnant T1DM patients, is promising for optimal glycemic control. Methods: We collected CGM metrics, HbA1c levels, insulin pump settings, and doses from a 33-year-old pregnant woman with 23-year history of T1DM from the 6th week of gestation to birth. She was initially on continuous insulin pump therapy with CGM and switched to the AHCL system (MiniMedTM 780G, Medtronic, Northridge, CA, USA) between weeks 13 and 14. Results: The AHCL system improved glycemic control from weeks 14 to 26, achieving international guidelines with TIR = 72%, TAR = 24%, TBR = 4%. At week 30, TIR was 66%, TAR 31%. By altering diet and adding \u2018fake carbohydrates\u2019, she maintained TIR \u2265 70%, TBR \u2264 4%, TAR \u2264 26% from week 34 to birth. A healthy 4 kg, 53 cm baby boy was born at week 38. Conclusions: The use of the AHCL system holds significant promise for improving glycemic control in pregnancy. Optimal glycemic control with MiniMedTM 780G in pregnancy requires accurate carbohydrate counting, specific timing of insulin doses in relation to meal consumption and dietary choices that reduce the glycemic load of meals continue to be crucial factors in achieving optimal glycemic control during pregnancy using the MiniMedTM 780G system. Further research and clinical studies are needed to explore the full potential of these advanced systems in managing T1DM during pregnancy and optimizing maternal and neonatal outcomes.<\/jats:p>","DOI":"10.3390\/jcm13051441","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T06:07:53Z","timestamp":1709273273000},"page":"1441","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Use of Advanced Hybrid Closed-Loop System during Pregnancy: Strengths and Limitations of Achieving a Tight Glycemic Control"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9413-6368","authenticated-orcid":false,"given":"Parthena","family":"Giannoulaki","sequence":"first","affiliation":[{"name":"Department of Clinical Nutrition, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4841-1928","authenticated-orcid":false,"given":"Evangelia","family":"Kotzakioulafi","sequence":"additional","affiliation":[{"name":"Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Faculty of Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandros","family":"Nakas","sequence":"additional","affiliation":[{"name":"Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Faculty of Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zisis","family":"Kontoninas","sequence":"additional","affiliation":[{"name":"Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Faculty of Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Polykarpos","family":"Evripidou","sequence":"additional","affiliation":[{"name":"Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Faculty of Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0236-8760","authenticated-orcid":false,"given":"Triantafyllos","family":"Didangelos","sequence":"additional","affiliation":[{"name":"Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Faculty of Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1001\/jama.2019.4981","article-title":"Management of Preexisting Diabetes in Pregnancy: A Review","volume":"321","author":"Alexopoulos","year":"2019","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1007\/s00125-009-1633-z","article-title":"Insulin Requirements throughout Pregnancy in Women with Type 1 Diabetes Mellitus: Three Changes of Direction","volume":"53","author":"Gich","year":"2010","journal-title":"Diabetologia"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e121","DOI":"10.2337\/dc13-2535","article-title":"Pharmacokinetics of Insulin Aspart in Pregnant Women with Type 1 Diabetes: Every Day Is Different","volume":"37","author":"Goudie","year":"2014","journal-title":"Diabetes Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.2337\/dci19-0028","article-title":"Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations from the International Consensus on Time in Range","volume":"42","author":"Battelino","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1016\/S0140-6736(17)32400-5","article-title":"Continuous Glucose Monitoring in Pregnant Women with Type 1 Diabetes (CONCEPTT): A Multicentre International Randomised Controlled Trial","volume":"390","author":"Feig","year":"2017","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1007\/s00125-019-4850-0","article-title":"Continuous Glucose Monitoring in Pregnant Women with Type 1 Diabetes: An Observational Cohort Study of 186 Pregnancies","volume":"62","author":"Kristensen","year":"2019","journal-title":"Diabetologia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1089\/dia.2021.0203","article-title":"Real-World Performance of the MiniMedTM 780G System: First Report of Outcomes from 4120 Users","volume":"24","author":"Silva","year":"2022","journal-title":"Diabetes Technol. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2527","DOI":"10.2337\/dc11-1430","article-title":"Safety and Efficacy of 24-h Closed-Loop Insulin Delivery in Well-Controlled Pregnant Women with Type 1 Diabetes","volume":"34","author":"Murphy","year":"2011","journal-title":"Diabetes Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"406","DOI":"10.2337\/dc10-1796","article-title":"Closed-Loop Insulin Delivery during Pregnancy Complicated by Type 1 Diabetes","volume":"34","author":"Murphy","year":"2011","journal-title":"Diabetes Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1056\/NEJMoa1602494","article-title":"Closed-Loop Insulin Delivery during Pregnancy in Women with Type 1 Diabetes","volume":"375","author":"Stewart","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.2337\/dc17-2534","article-title":"Day-and-Night Closed-Loop Insulin Delivery in a Broad Population of Pregnant Women with Type 1 Diabetes: A Randomized Controlled Crossover Trial","volume":"41","author":"Stewart","year":"2018","journal-title":"Diabetes Care"},{"key":"ref_12","first-page":"7310176","article-title":"The Closed-Loop System Improved the Control of a Pregnant Patient with Type 1 Diabetes Mellitus","volume":"2021","author":"Viggiano","year":"2021","journal-title":"Case Rep. Endocrinol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.aace.2020.11.039","article-title":"Commercialized Hybrid Closed-Loop System (Minimed Medtronic 670G) Results during Pregnancy","volume":"7","year":"2021","journal-title":"AACE Clin. Case Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e3248","DOI":"10.1002\/dmrr.3248","article-title":"Case Series of a Hybrid Closed-loop System Used in Pregnancies in Clinical Practice","volume":"36","author":"Polsky","year":"2020","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"110800","DOI":"10.1016\/j.diabres.2023.110800","article-title":"Off-Label Use of an Automated Insulin Delivery System in Pregnant Women with Type 1 Diabetes","volume":"202","author":"Albert","year":"2023","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1089\/dia.2023.0031","article-title":"Real-World Insulin Treatment in Pregnant Women with Type 1 Diabetes Using an Advanced Hybrid Closed-Loop System","volume":"25","author":"Dodesini","year":"2023","journal-title":"Diabetes Technol. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1089\/dia.2023.0267","article-title":"MiniMed TM 780G Advanced Hybrid Closed-Loop System Study in Pregnant Women with Type 1 Diabetes","volume":"25","author":"Guibert","year":"2023","journal-title":"Diabetes Technol. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Munda, A., Kovacic, C., and Pongrac Barlovic, D. (2022). Carbohydrate Intake and Closed-Loop Insulin Delivery System during Two Subsequent Pregnancies in Type 1 Diabetes. Metabolites, 12.","DOI":"10.3390\/metabo12111137"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e15086","DOI":"10.1111\/dme.15086","article-title":"Real-world Use of Control-IQ\u00a0TM Technology Automated Insulin Delivery in Pregnancy: A Case Series with Qualitative Interviews","volume":"40","author":"Wang","year":"2023","journal-title":"Diabet. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S254","DOI":"10.2337\/dc23-S015","article-title":"15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2023","volume":"46","author":"ElSayed","year":"2023","journal-title":"Diabetes Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1007\/s00125-011-2363-6","article-title":"Pathophysiology of Postprandial Hyperglycaemia in Women with Type 1 Diabetes during Pregnancy","volume":"55","author":"Murphy","year":"2012","journal-title":"Diabetologia"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S2213-8587(20)30406-X","article-title":"Characteristics and Outcomes of Pregnant Women with Type 1 or Type 2 Diabetes: A 5-Year National Population-Based Cohort Study","volume":"9","author":"Murphy","year":"2021","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1089\/dia.2017.0030","article-title":"Maternal-Fetal Outcomes in 34 Pregnant Women with Type 1 Diabetes in Sensor-Augmented Insulin Pump Therapy","volume":"19","year":"2017","journal-title":"Diabetes Technol. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.2337\/dc22-0078","article-title":"Continuous Glucose Monitoring Metrics and Birth Weight: Informing Management of Type 1 Diabetes throughout Pregnancy","volume":"45","author":"Scott","year":"2022","journal-title":"Diabetes Care"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Beunen, K., Van Wilder, N., Ballaux, D., Vanhaverbeke, G., Taes, Y., Aers, X.-P., Nobels, F., Marlier, J., Lee, D., and Cuypers, J. (2023). Closed-Loop Insulin Delivery in Pregnant Women with Type 1 Diabetes (CRISTAL): A Multicentre Randomized Controlled Trial\u2014Study Protocol. BMC Pregnancy Childbirth, 23.","DOI":"10.1186\/s12884-023-05481-0"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S109","DOI":"10.1016\/S0168-8227(11)70025-0","article-title":"Insulin pump therapy in adults","volume":"93","author":"Didangelos","year":"2011","journal-title":"Diabetes Res. Clin. Pract."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/5\/1441\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:07:57Z","timestamp":1760105277000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/5\/1441"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,1]]},"references-count":26,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["jcm13051441"],"URL":"https:\/\/doi.org\/10.3390\/jcm13051441","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,1]]}}}