A Q&A with Kevin Malloy, PharmD, BCPS, on how diabetes technology has improved and how it can help pregnant people manage their disease.
Technology for the self-management of diabetes has improved significantly over the past several years, with devices like continuous glucose monitors (CGM) helping patients control the disease. These novel devices have also been shown to improve measures in pregnant people, lowering the potential risk of negative maternal and fetal outcomes.
Drug Topics sat down with Kevin Malloy, PharmD, BCPS, to discuss how new diabetes technology can help pregnant people manage the condition, the utility of CGM use in pregnancy, and how pharmacists can help pregnant people use CGMs.
Drug Topics: There have been significant developments in the diabetes technology space in the last few years. How can this technology help pregnant people with diabetes manage their condition?
Kevin Malloy, PharmD, BCPS: I think probably the biggest one that's kind of finally coming to fruition after decades of research is the first approval of continuous glucose monitor for pregnancy, the Dexcom G7, and then most recently, the updated sensors for Freestyle Libre 2 and Freestyle Libre 3 in March of this year. I think that that is great and really, thinking historically, we have been collecting data for CGM use in pregnancy for going on 20 years now. That really, really puts into focus how difficult it is to study these devices and ultimately get approval for these devices for use in pregnancy. I think that is very exciting.
But then also something that we sort of need to think about from a regulatory standpoint, while we're being very cautious in a vulnerable population, that does ultimately lead to a lack of data and a lack of regulatory approval. It's very exciting with CGM use and I think what we can potentially derive from that is we have overall a very minimally invasive device that's going to guide maybe more invasive devices, such as insulin pumps, that automatically adjust insulin delivery. I think if we can use that as sort of a base point, it should make us a little more comfortable when it comes to putting these things in a really vulnerable population that has historically had so many issues with being able to achieve optimal glycemic control, really trying to push that needle of getting better risk of maternal and fetal complications that a woman without diabetes, for lack of a better expression, we really need all hands on deck and I don't think it's really a time that we want to be withholding some of these technologies solely because of a lack of reported evidence for the use of these types of technologies that are relatively minimally invasive.
Drug Topics: Can you talk about the utility of CGM in pregnancy? How can pharmacists help pregnant people using CGMs monitor their condition?
Malloy: We have seen, even in a much older trial, the pivotal concept trial published in 2017 that compared adjunctive CGM use on top of blood glucose monitoring versus blood glucose monitoring alone in women planning and the cohort of women already pregnant in the first trimester, even in relatively dated devices, we don't really use adjunctive CGM use frequently, even with that device, we found an improvement in maternal glycemic outcomes and more importantly, an improvement in maternal and neonatal outcomes with the use of CGM. There's many trials currently undergoing, not just in preexisting type 1 diabetes in pregnancy, but also preexisting type 2 and gestational diabetes, of how these devices can be used to overall improve glycemic control.
What we ultimately want is to improve maternal fetal obstetric outcomes in these patients. I think that is data that we are currently collecting on some of our newer devices. If we look at our older trials that are using devices that are much less practical, we could assume potentially fairly or unfairly that our newer devices would really do better, especially with more routine use of many providers having increased comfort with CGM.