SUN-518 Is there a better Insulin Pump for pregnancy?

Abstract Disclosure: A.A. Joshi: None. F. Erenler: None. Pregnancies in women with type 1 diabetes continue to be at increased risk of potentially serious complications. Many physiologic changes throughout pregnancy make frequent insulin adjustments and close follow-up necessary. Automation of insulin delivery with a hybrid closed-loop system has the potential to improve glycemic outcomes in pregnant women with T1D. We compared the Omnipod 5 pump to Tandem t:slim X2 (Control-IQ) Background: 33 year old with T1D which was diagnosed at age 13 in 2004 with DKA. In 2013 she started using Tandem Slim pump and was on it from 2013-2023; she then switched to OmniPod 5 closed loop system 12/2023 -1/2025 due to tube clogging issues with Tandem. In 9/2024 she became Pregnant and was having frequent night time hyperglycemia, mostly driven by automated mode target in Omnipod being higher than 60-90 mg/ dL. Our team initially advised her to use manual mode in Omnipod 5 pump from 12 AM to 8 AM with a basal rate 0.95 Units/hr; ICR adjusted to 4.6 and it was noted that sugars were more in target. However given more persistent hyperglycemia episodes on 1/22/25 she switched back to Tandem given night control being much better with Tandem as observed by her during previous pregnancy. Methods: - Omnipod 5 settings were as follows: Manual mode 12AM - 8 AM ,basal rate 0.65 Units /hour overnight, during the day basal rate was 0.95 Units/hr and ICR: 1:4.6. -Tandem t slim x2 (CONTROL IQ ) setting were as follows: 12 AM - 6 AM 1.2 Units/hr, 6AM - 10 AM 0.9 Units/hr, 10 AM - 12 PM 0.875 Units/hr, 12 PM - 3 PM 1.0 Unit /hr, 3 PM - 12 AM 1.1 Units/hr, Carb ratio 1 :3.6 , Sensitivity factor 1 :40. Results: We observed that with Omnipod 5 (2 weeks review): She had a GMI of 5.9 %, with Average blood glucose 106 mg/dl, TIR 84 %, Total insulin requirement of 51 units per day with 28 % basal and 72 % bolus/day, to be noted she used the pump 67 % in Auto mode and 33 % (night time ) in manual mode. With her switch to Tandem t:slim X2 (Control-IQ) we noted that in 2 weeks she had TIR 86 %, average blood glucose 108 mg/dl and Total insulin requirement per day 60.57 units with 26 % basal and 74 % bolus/day. To be noted she had consistent Carbohydrate intake of 166-177 gm of Carbs/day with both the pumps. We noted that glycemic control for nights was still a bit high although slightly better with Tandem t slim X2. She was appropriately bolusing for each meal and there was no significant change in her activity levels. Conclusion: We noted that OmniPod 5 required approximately 10 units less insulin/day, it was more convenient given no issue of tube clogging which was reported by our patient with t Slim X2, however the biggest advantage of t slim x2 was better night time control and ease of use.This area of diabetes research also opens doors to potential designs of newer pumps which can be customized for pregnancy with settings to meet the glycemic control targets in pregnancy and make it easier for use. Presentation: Sunday, July 13, 2025