| name | pdm-hcl-pump-t1dm |
| description | Recommends use of hybrid closed-loop pump rather than insulin pump with CGM (without algorithm) or multiple daily injections with CGM for pregnant individuals with type 1 diabetes. Triggered when deciding on insulin delivery methods for pregnant patients with type 1 diabetes. |
Use hybrid closed-loop pump in pregnancy for type 1 diabetes
STEP 1 — Gather Information
Confirm pregnancy, type 1 diabetes diagnosis, current insulin delivery method, CGM use, recent glycemic metrics (time in range, hypoglycemia), and patient preferences regarding technology.
STEP 2 — Rule In / Rule Out
Is the individual pregnant with type 1 diabetes? If yes, proceed; if no, this skill does not apply.
STEP 3 — Classify or Stratify
Determine whether the patient is currently using an insulin pump with CGM (without algorithm) or multiple daily injections with CGM. If yes, they are a candidate for switching to HCL pump; if already using HCL pump, continue current therapy.
STEP 4 — Decide
Recommend initiating or continuing a hybrid closed-loop pump system rather than insulin pump with CGM (without algorithm) or multiple daily injections with CGM, after shared decision making and ensuring access to appropriate HCL technology.
Clinical Guardrails / Mimics / Pitfalls
Not all HCL algorithms are validated for pregnancy; avoid systems without pregnancy‑specific glucose target capabilities. Ensure clinician expertise in both diabetes management during pregnancy and HCL technology. Monitor for device failure, skin irritation, and over‑reliance on automation without periodic review. Do not use HCL as a substitute for preconception care or regular obstetric follow‑up.
Concrete Clinical Example
A 30‑week pregnant woman with T1DM using MDI and CGM reports frequent nocturnal hypoglycemia and time in range of 55%. After discussing options, she switches to an HCL pump with a pregnancy‑approved algorithm, achieving time in range of 70% and reduced hypoglycemia within two weeks.
Source: Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline, Endocrine Society & European Society of Endocrinology, 2025, https://doi.org/10.1210/clinem/dgaf288
