Search Results (47)

Background/Objectives: Type 1 diabetes (T1D) is a heterogeneous disease in terms of clinical presentation, treatment requirements, and risk of complications. The identification of biological endotypes and clinical phenotypes has been proposed to support precision medicine approaches. We aimed to assess the prevalence and clinical characteristics of age-at-diagnosis-based endotypes, adult-onset phenotypes, and insulin-resistant phenotypes in a real-world cohort of adults with T1D. Methods: We conducted a single-center, observational, cross-sectional study including adults (≥18 years) with clinically confirmed T1D under active follow-up. Clinical, metabolic, and treatment-related variables were analyzed across predefined age-at-diagnosis-based endotypes and clinical phenotypes. Results: A total of 868 patients were included (median age 49 years; diabetes duration 23 years; age at diagnosis 20 years; 51.5% women). Continuous subcutaneous insulin infusion (CSII) was used by 20.4% of patients, and continuous glucose monitoring (CGM) was used by 95.3%. Mean HbA1c was 7.47%, with a median time in range (TIR) of 63%. The prevalence of age-at-diagnosis-based endotype 1 (ED1) was 11.8%, adult-onset phenotype was 31.3%, and insulin-resistant phenotype was 7.3%. No major differences in glycemic control were observed across age-at-diagnosis-based endotypes. Associations between endotypes and treatment-related variables were largely explained by current age and diabetes duration. In contrast, the adult-onset phenotype was independently associated with lower TIR, higher time above range, lower use of CSII, and greater use of adjunctive therapies. The insulin-resistant phenotype was associated with higher HbA1c, lower TIR, and greater therapeutic complexity. Conclusions: Adult T1D shows marked heterogeneity. In this real-world cohort, age-at-diagnosis-based endotypes were not independently associated with major clinical differences after adjustment for current age and diabetes duration. In contrast, adult-onset and insulin-resistant phenotypes identified subgroups with poorer glycemic control and greater therapeutic complexity. Full article

Background/Objectives: Advanced technologies in type 1 diabetes mellitus (T1DM) management have reshaped the strategies used to achieve optimal glucose control. Continuous subcutaneous insulin infusion (CSII) and automated insulin delivery (AID) systems are effective alternatives to multiple daily injections (MDI). This study aims to evaluate glycemic regulation in children and adolescents transitioning from MDI to insulin pumps and to raise awareness among patients and their families regarding the benefits of these systems. Methods: 50 pediatric patients with T1DM (24 males, 26 females; mean age 10.76 ± 3.2 years) were evaluated. Cycle 1 established MDI metrics 3 months pre-transition. In cycle 2, patients transitioned either to an AID system (Medtronic MiniMed 780G, (Northridge, CA, USA), 78%), or a non-automated system (Omnipod DASH, 22%). Data were assessed at 3 and 6 months post-initiation. Parameters assessed were glycosylated hemoglobin (HbA1c), time in range (TIR), time above range (TAR), time below range (TBR), glucose management indicator (GMI) and coefficient of variation (CV). Results: The cohort exhibited a statistically significant increase in TIR (p = 0.0038) with mean values of 70.9% at 3 months and 73.2% at 6 months. TAR significantly reduced (p = 0.033) to 26.5% and 24.3% at 3 and 6 months, respectively. Sub-analysis in the AID group revealed a marked increase in TIR (p = 0.0001) alongside significant reductions in TAR (p = 0.0009) and GMI (p = 0.03). Conclusions: Transitioning from MDI to insulin pump therapy, particularly AID systems, leads to modest but significant improvements in specific sensor metrics (TIR, TAR) in real-world clinical practice. The consistency of these results across age groups indicates that AID systems can successfully overcome pediatric and adolescent diabetes management challenges. Full article

Background/Objectives: Nocturnal glycemic variability in pediatric type 1 diabetes (T1D) disrupts caregiver sleep and quality of life; advanced hybrid closed-loop (AHCL) systems may be associated with reduced caregiver burden by providing more stable overnight glucose control. We aimed to evaluate changes in caregiver-reported sleep quality and continuous glucose monitoring (CGM) targets three months after transition to an AHCL system. Methods: We conducted a prospective single-center real-world study in a tertiary pediatric diabetes unit that included children aged 6–17 years with T1D who switched from continuous subcutaneous insulin infusion (MiniMed) and intermittently scanned CGM (FreeStyle Libre 2) to an AHCL system (MiniMed 780G) with Guardian 4 sensor. Caregivers completed the Pittsburgh Sleep Quality Index (PSQI) at baseline and after 3 months; CGM metrics (TIR 70–180 mg/dL, TAR1 180–250 mg/dL, TAR2 > 250 mg/dL, TBR1 54–70 mg/dL, TBR2 < 54 mg/dL) were extracted at the same time points. Analyses used Shapiro–Wilk, Wilcoxon signed-rank, Spearman correlations, and McNemar tests (α = 0.05). Results: Twenty-two caregivers completed baseline PSQI; 16 provided PSQI data at three months. The proportion with PSQI > 5 decreased from 56.3% to 18.8% (p = 0.034), and 81.3% showed lower global PSQI at 3 months (p = 0.018). The largest mean improvements were observed in daytime dysfunction (−0.94), subjective sleep quality (−0.81), and sleep duration (−0.63), with slight increases in sleep disturbance (+0.13) and sleep-medication use (+0.13). The proportion of participants meeting international CGM consensus targets improved: the percentage achieving TIR > 70% increased from 26.7% to 80.0% (p = 0.008); those meeting TAR > 180 mg/dL < 30% increased from 26.7% to 80.0% (p = 0.008); and those meeting TAR2 > 250 mg/dL < 5% increased from 20.0% to 53.3% (p = 0.008). Hypoglycemia-related targets showed no significant change, and no episodes of symptomatic or level 3 hypoglycemia were reported. Exploratory analyses suggested that poorer PSQI at 3 months was associated with greater Δ TBR1, and increases in TAR2 with higher sleep disturbance and sleep-medication use. Conclusions: Transition to an AHCL system was associated with improvements in caregiver-reported sleep and attainment of CGM consensus targets within three months. Residual nocturnal hyperglycemia was associated with features of ongoing sleep disturbance, highlighting the potential relevance of individualized alert settings, sleep-focused education, and inclusion of objective sleep measures in future studies. Full article

Background/Objectives: Regular physical exercise is strongly recommended for individuals with type 1 diabetes mellitus (T1DM) because of its beneficial effects on cardiovascular fitness, insulin sensitivity, metabolic control, and overall health. Nevertheless, participation in physical activity remains limited, largely due to the fear of exercise-induced hypoglycemia and glycemic instability. Glycemic responses to exercise in T1DM are influenced by the interaction between exercise modality, circulating insulin levels, nutritional status, and diabetes technologies. Continuous aerobic exercise, resistance training, high-intensity interval exercise, and mixed intermittent activities elicit distinct metabolic and hormonal responses, resulting in heterogeneous glycemic trajectories. This narrative review aimed to provide a clinically oriented synthesis of the physiological mechanisms underlying exercise-related glycemic fluctuations in T1DM and to discuss integrated insulin- and carbohydrate-based strategies to support safer participation in physical activity in the context of modern diabetes technologies. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and complementary searches in Google Scholar to identify experimental studies, observational studies, systematic reviews, consensus statements, and clinical guidelines focused on exercise-related glycemic responses in individuals with T1DM. Only articles published in English were considered. Evidence was selected and synthesized according to relevance to exercise modality, insulin therapy strategies, carbohydrate management, and diabetes technologies, including continuous glucose monitoring, continuous subcutaneous insulin infusion, and automated insulin delivery systems. The final narrative synthesis was based on 44 selected studies, reviews, consensus statements, and guidance documents considered most relevant to the objectives of this narrative review. Results: Available evidence indicates that continuous moderate-intensity aerobic exercise is most consistently associated with progressive glucose declines and increased risk of hypoglycemia, particularly when performed in the presence of elevated insulin on board. In contrast, resistance exercise and short-duration high-intensity or anaerobic exercise more frequently induce stable glycemia or transient hyperglycemia through adrenergic stimulation and increased hepatic glucose output. Mixed and intermittent exercise modalities often produce more variable responses depending on exercise sequencing, nutritional status, and insulin exposure. Across studies, integrated adjustment of basal and prandial insulin doses together with individualized carbohydrate supplementation emerged as the most effective strategy to reduce exercise-related glycemic instability. Continuous glucose monitoring and insulin pump technologies improved glucose trend awareness and management flexibility; however, physical exercise remains a challenging condition for current automated insulin delivery algorithms and still requires active user-driven decision-making. Conclusions: Exercise management in T1DM should be based on an individualized interpretation of exercise modality, glucose trends, insulin exposure, and nutritional context rather than on fixed glucose thresholds alone. Combining anticipatory insulin adjustments, tailored carbohydrate strategies, and appropriate use of diabetes technologies may substantially reduce glycemic variability and improve confidence toward physical activity participation. Structured education and individualized clinical guidance remain essential to translate physiological knowledge into effective real-world exercise management. Full article

Background and Aims: Automated insulin delivery (AID) systems are standard of care for type 1 diabetes mellitus (T1DM). Tubeless AID systems may improve treatment acceptance, but real-world European data in patients transitioning from multiple daily injections (MDI) or open-loop patch pump therapy are limited. This study evaluated real-world glycemic, safety, and quality-of-life (QoL) outcomes after transition to a tubeless automated closed-loop system (Omnipod 5^®, OP5^®). Research Design and Methods: In this prospective, multicenter observational study, adults with T1DM transitioned from MDI or open-loop continuous subcutaneous insulin infusion to OP5^® and were followed for 180 days. Continuous glucose monitoring-derived metrics and validated patient-reported outcome measures were assessed. Subgroup analyses were performed by prior therapy. Results: Of the 94 enrolled participants, 88 completed the study. At 180 days, HbA1c decreased from 7.5% to 7.1% (p < 0.001), and time in range increased from 59.0% to 68.0% (p < 0.001) without increased hypoglycemia. The proportion achieving TIR_70–180 ≥ 70% rose from 12.5% to 43.2%. Improvements were greater among prior MDI users. Treatment satisfaction and diabetes-related QoL improved significantly. The mean time in automated mode was 90.9%. Conclusions. Transition to tubeless AID significantly improved glycemic and psychosocial outcomes, supporting its effectiveness in routine clinical practice. Full article

Severe congenital Protein C deficiency (SCPCD) is a rare autosomal recessive thrombophilia that typically presents in the neonatal period with early-onset life-threatening thrombotic complications. We report the case of a female infant who presented at birth with digital ischemic necrosis and laboratory evidence of consumptive coagulopathy consistent with neonatal purpura fulminans. Severe Protein C deficiency was confirmed by markedly reduced Protein C activity (<0.03 IU/mL) and compound heterozygous variants in the PROC gene. After initial stabilization and intermittent intravenous Protein C replacement, pharmacokinetic assessment showed marked peak–trough variability. Continuous subcutaneous infusion of Protein C concentrate was therefore initiated using a programmable insulin pump in combination with oral anticoagulation. This strategy achieved stable Protein C activity levels, allowed progressive reduction of the weight-adjusted replacement dose, and enabled removal of the central venous catheter. Continuous subcutaneous infusion of Protein C concentrate via an insulin pump, combined with oral anticoagulation, may represent a feasible long-term therapeutic option in selected patients with SCPCD. Full article

Background: Carbohydrate quality and culinary processing can meaningfully alter postprandial glycemia in people with type 1 diabetes (T1D). Cooling gelatinized starch promotes retrogradation and increases resistant starch (RS), potentially attenuating postprandial glucose excursions. Objectives: We investigated whether pasta cooled after cooking (24 h at 4 °C) and reheated before consumption improves postprandial glycemia in adults with T1D without increasing hypoglycemia risk under routine insulin pump bolus-calculator dosing. Methods: In this randomized, single-blind, crossover study, 32 adults with T1D treated with continuous subcutaneous insulin infusion (CSII) consumed two standardized pasta-based meals (50 g of available carbohydrate): freshly cooked pasta and cooled/reheated pasta. Participants administered rapid-acting insulin boluses calculated by their pump bolus calculator 10 min before the meal. Interstitial glucose was recorded for 180 min using flash glucose monitoring. Results: Compared with freshly cooked pasta, cooled/reheated pasta produced lower maximum glycemia (10.7 vs. 12.6 mmol/L, p = 0.0001), lower maximum glycemic rise (2.8 vs. 4.7 mmol/L, p < 0.0001), lower incremental area under the curve (iAUC; 211.9 vs. 524.8 mmol/L × 180 min, p < 0.0001), and a shorter time-to-peak (65 vs. 125 min, p = 0.014). Resistant starch content increased after cooling (12.88 ± 0.06 vs. 8.03 ± 0.08 g/100 g). The number of hypoglycemic episodes did not differ between conditions. Conclusions: Cooling and reheating pasta therefore increased RS and attenuated postprandial glycemia in adults with T1D without increasing early postprandial hypoglycemia in the studied setting. Full article

Background/Objectives: Optimal postprandial glycemic control is crucial to maintain time in range (TIR:3.9–10.0 mmol/L, 70–180 mg/dL) and time in tight range (TITR:3.9–7.8 mmol/L, 70–140 mg/dL), both important to reduce microvascular complications in type 1 diabetes mellitus (T1DM). However, insulin dosing based on carbohydrate counting fails to compensate for delayed hyperglycemia from protein and fat. This study evaluated two advanced insulin dosing algorithms designed to improve postprandial control in adolescents with T1DM. Methods: In this randomized, prospective, double-blind, crossover trial, 58 adolescents with T1DM (median age 15.5 years) were enrolled, all using continuous subcutaneous insulin infusion and a continuous glucose monitoring system in non-automated mode. For two consecutive days, participants consumed standardized mixed meals for breakfast (50 g of carbohydrates, 200 kcal from protein and fat) and received an extended bolus delivered for four hours, based on the Pankowska Equation (PE, i.e., Fat-Protein Units × Insulin-to-Carbohydrate Ratio (ICR)) and the Sieradzki Equation (SE, i.e., 30% × Carbohydrate Units × ICR). Postprandial glucose was monitored for five hours using a glucometer and Continuous Glucose Monitoring (CGM). The primary outcome was the capillary blood glucose level at predefined time points. The secondary outcomes were the frequency of hypoglycemia and glycemic variability parameters. Results: Both methods kept postprandial glucose within the recommended TIR. The SE method provided longer TITR (82.51% vs. 70.49%, p = 0.6281) and fewer hypoglycemic episodes at 180 and 300 min. Glucose levels at 60 min, were higher after PE (136 ± 35.2 mg/dL vs. 124 ± 32.2 mg/dL, p = 0.016). Conclusions: Both algorithms provided effective postprandial control after a mixed meal, but SE achieved a longer TITR and fewer late hypoglycemic events. Full article

Background and Objectives: Eating disorders are one of the most widespread health concerns, mainly among adolescents. Children and adolescents with type 1 diabetes mellitus (T1DM) have been reported to have a high prevalence of eating disorders. The aim of our study is to evaluate the risk of diabetes-specific eating disorders in children with T1DM using continuous subcutaneous insulin infusion (CSII), with real-time glycemic data from continuous glucose monitoring (CGM). Materials and Methods: Sixty-four patients (aged 7–18 years) completed the Diabetes Eating Problem Survey-Revised (DEPS-R). The DEPS-R is a diabetes-specific self-report questionnaire to assess diabetes-specific compensatory behaviors. Auxological findings, sex, age, age at diagnosis, hemoglobin A1c (HbA1c) levels, and all CGM data were obtained from their medical records. Results: Although the median DEPS-R score was higher in children and adolescents using CSII compared to those using multiple daily injections (MDIs) (14 vs. 11), the difference was not statistically significant (p = 0.302). The risk of diabetes-specific eating disorders was identified in six patients (30%) using CSII and in nine patients (20.4%) using multiple daily injections (p = 0.403). Interestingly, in the subgroup with poor glycemic control (HbA1c > 9%), DEPS-R scores were significantly lower among those using CSII compared to the MDI group. Pearson correlation analysis demonstrated positive associations between DEPS-R scores and diabetes duration, weight SDS, body mass index (BMI), BMI SDS, HbA1c, mean glucose, Glucose Management Indicator (GMI), time above range (TAR) (very high), and coefficient of variation (CV), while a moderate negative correlation was observed with time in range (TIR). Conclusions: This study showed that the treatment of CSII had a beneficial effect on the risk of eating disorders in patients with poor glycemic control. As well, from this perspective, CSII maintains its status as a potentially beneficial therapeutic approach in diabetes management. Full article

Introduction: In healthcare centers with limited resources, or for patients who prefer to make continuous changes in their treatment themselves and do not want to rely solely on technology, intermittent glucose monitoring (isCGM) with an insulin pump is a viable option that warrants further study. Material and methods: prospective single-center study that collected data at 3 months and after isCGM implantation in pediatric patients with Type 1 diabetes, categorized according to their insulin regimen. Results: We found statistically significant differences in the time in range (TIR) between 70 and 180 mg/dl at 3 months after using the sensor (p = 0.017), although these differences were not maintained at 1 year (p = 0.064). When stricter TIRs (70–140 mg/dl) were analyzed, statistically significant differences were observed at 3 months (p = 0.01) and at 1 year (p = 0.018) in favor of patients using CSII. While 75% of the patients in the CSII group had good control with HbA1c < 7% after one year of sensor use, only 34.6% in the MDI group achieved these values. However, the CSII group presented a higher coefficient of variation (62.31% at 3 months and 43.08% at 1 year) (p = 0.02), and a higher number of hypoglycemic episodes (7.38% and 7.32%, respectively) (p = 0.016). The CSII group also had a higher number of capillary blood glucose measurements at the beginning of the study (8.32/day) (p = 0.249), but this number became similar between both groups after one year. Conclusions: We found statistically significant differences in favor of CSII over MDI in terms of metabolic control after one year of isCGM use. However, the TIR values were still below the range considered to be indicative of good control. These findings lead us to question whether CSII should be initially considered in specific cases where HCL is not possible, or if it would be more effective to wait until the patient is ready, or the necessary resources are available to start directly CSII integrated in a closed loop system. Full article

Background/Objectives: Compared to in the general pregnant population, pregnancy in women with type 1 diabetes (T1D) is still associated with an increased number of perinatal complications affecting both the fetus and the mother. The Great Orchestra of Christmas Charity Foundation (GOCCF) program enables the use of continuous subcutaneous insulin infusion (CSII) enhanced by a hypo-stop function and real-time continuous glucose monitoring (rtCGM) during the preconception or early pregnancy period in patients with T1D. This observational study aimed to analyze the association between pregnancy planning and pregnancy outcomes in patients who qualified for the GOCCF program. Methods: Ninety-eight women with T1D, aged 21–41 years, who began using the CSII + rtCGM system at the planning/early pregnancy stage or at a later stage in the case of an unplanned pregnancy, were eligible for this study. We analyzed glucose control, the insulin requirements, the pregestational BMI, the maternal weight gain, the occurrence of preterm births, congenital malformations and the birthweight of newborns. Results: Women who planned their pregnancies had significantly better glycemic control before and throughout the entire pregnancy, and a significantly higher proportion of them achieved a TIR (time in range) > 70% (58.7% vs. 28.9%, p = 0.014) and TAR (time above range) < 25% (65.2% vs. 24.4%, p < 0.001). Their glucose variability at the end of the pregnancy was significantly lower (29.4 ± 5.5 vs. 31.9 ± 5.1, p = 0.030). They also gave birth later, at a mean of 37.8 ± 0.9 weeks compared to 36.9 ± 1.8 weeks in the non-planned group (p = 0.039). Preterm birth occurred in five women (10.4%) who planned their pregnancies and in fifteen women (30%) who did not, with p = 0.031. Conclusions: Pregnancy planning in women with type 1 diabetes (T1D) is associated with better glucose control before conception and throughout the entire pregnancy, resulting in better pregnancy outcomes. Full article

Introduction: Managing glycemic fluctuations in critically ill elderly patients with type 2 diabetes mellitus (T2DM) poses significant challenges. This case report presents a unique scenario in which increased intravenous glucose (Glc) infusion, together with insulin therapy, improved glycemic control and reduced insulin requirements during a septic episode. This finding adds to the scientific literature by suggesting that adequate Glc administration may enhance insulin sensitivity in critically ill T2DM patients. Case report: An 84-year-old female patient with T2DM, hypertension, and chronic renal failure was admitted to the intensive care unit with fever, nausea, loss of appetite, and profound weakness. Laboratory findings revealed severe hyperglycemia, electrolyte imbalances, and markedly elevated inflammatory markers, leading to the diagnosis of decompensated T2DM that was complicated by sepsis. The initial treatment consisted of continuous intravenous (IV) insulin, crystalloid infusions, and broad-spectrum antibiotics. Despite insulin therapy and the absence of nutritional intake, the patient experienced extreme fluctuations in their blood glucose levels, ranging from hyperglycemia to hypoglycemia. Due to persistent glycemic instability, IV Glc infusion was initiated alongside continuous insulin therapy. Paradoxically, increasing Glc infusion administration rate led to a reduction in the required insulin doses and stabilization of blood glucose levels below 10 mmol·L⁻¹. The patient’s C-peptide levels were initially elevated but subsequently decreased following Glc administration as well, suggesting a reduction in endogenous insulin secretion and therefore higher insulin sensitivity. The patient’s clinical condition improved, allowing for the transition to a subcutaneous insulin regime and the initiation of oral feeding. She was later transferred to a general medical ward and discharged without further complications. Conclusions: This case highlights the complex interplay between Glc and insulin in critically ill elderly patients with T2DM during sepsis. The main takeaway is that carefully managed Glc infusion, in conjunction with flexible insulin therapy, can enhance insulin sensitivity and stabilize blood glucose levels without causing further hyperglycemia. Frequent glycemia monitoring and adaptable glycemic management strategies are essential in the ICU to address rapid glycemic fluctuations in this patient population. Full article

Background/Objectives: The association between sexual dysfunction and diabetes is well known, but few studies have investigated its prevalence in type 1 diabetes (T1D). The aim of this study was to evaluate the prevalence of sexual dysfunction in a group of women with T1D, regardless of their age, and to compare its different prevalences in women treated with different insulin regimens. Methods: The population included 77 women affected by T1D, of which 16 were on Multiple Daily Injections (MDI) and 61 on Continuous Subcutaneous Insulin Infusion (45 on Advanced Hybrid Closed Loop System with catheter and 16 on patch pump). All participants completed the Female Sexual Function Index (FSFI), a questionnaire that evaluates several aspects of sexual function. Another questionnaire that evaluated general features, diabetes-specific features and sexual-specific features was proposed to every participant. Results: The overall prevalence of female sexual dysfunction was 49.3%. A correlation was demonstrated between the prevalence of female sexual dysfunction and age; another correlation was found between the prevalence of female sexual dysfunction and dyadic status. No correlation between glycemic control and sexual dysfunction was found. Conclusions: Women with T1D presented a high prevalence of sexual dysfunction, independently from glycometabolic disease control and insulin regimens; on the other hand, a significant correlation was demonstrated with age and dyadic status. Evaluation of sexual function in women with T1D appears to be important in clinical settings independently from disease control. Full article

Background/Objectives: The association between sexual dysfunctions and diabetes is largely known, but few studies investigated its prevalence in Type 1 Diabetes (T1D). The aim of this study was to evaluate the prevalence of sexual dysfunction in a group of men with T1D regardless of their age and to compare the prevalence in men treated with different intensive insulin regimens. Methods: The study population included 68 men affected by T1D, of whom 17 were on Multiple Daily Injections (MDI) and 51 were on Continuous Subcutaneous Insulin Infusion (41 on Advanced Hybrid Closed Loop System with catheters and 10 on patch pumps). All participants completed the International Index of Erectile Function (IIEF-15), which evaluates several domains of sexual function. Another questionnaire that evaluated general features, diabetes-specific features, and sexual-specific features was proposed to every participant. Results: The overall prevalence of erectile dysfunction was 48.5%, and the overall prevalence of a severe grade of erectile dysfunction was 26.5%. Correlations were demonstrated between the prevalence of erectile dysfunction and age and between the prevalence of erectile dysfunction and dyadic status. Age and dyadic status were also correlated with lower scores in several other domains of the IIEF-15 questionnaire. Conclusions: Men with Type 1 Diabetes present a high prevalence of erectile dysfunction, independent of glycometabolic control of the disease and insulin regimens; on the contrary, a great correlation is demonstrated with age and dyadic status. Full article

Background: The management of type 1 diabetes in pregnancy with new technologies is challenging. Sometimes the complexity of new-generation systems such as “continuous subcutaneous insulin infusion, CSII” and patient or provider preference do not allow their use, so women with type 1 diabetes in pregnancy continue to be treated with subcutaneous multiple-injection insulin therapy using pens. Smart insulin pens are new tools that allow for data collection on insulin dose and time of administration and have additional connectivity features. Objective: To retrospectively describe the use of a smart insulin pen coupled with rt-CGM (InPen^TM system) in three pregnancies complicated by type 1 diabetes. Methods: Participants used the InPen^TM system in pregnancy and consented to analysis of glycaemic data and pregnancy outcome. Results: An increase in pregnancy specific time-in-range glucose was observed in the three patients related to the duration of insulin action, insulin sensitivity factors, and a pre-set target glucose range for pregnancy. No diabetic ketoacidosis or severe hypoglycaemia occurred. Conclusions: We describe practical considerations in three pregnant patients with type 1 diabetes where the InPen^TM system was used with suggestive improvements in the time-in-range. Full article