Permissive Versus Strict Intrapartum Glucose Management in Type 1 Diabetes (PRISM-T1D)
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Insulin, DEXCOM Continuous Glucose Monitor.
- Who it may be relevant to
- Registry conditions: Pregnancy, High Risk, Type 1 Diabetes. Basic parameters: from 18 years · Female.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- United States
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
PRISM-TID is a single center non-inferiority randomized controlled trial of permissive intrapartum glucose management (intervention) versus strict intrapartum glucose management (standard of care) among pregnant individuals with type 1 diabetes (T1D) using hybrid closed loop therapy (HCL) who are admitted for labor management. Participants will be randomized in a 1:1 fashion to one of two intrapartum glycemic control options: permissive (70-140 mg/dL) or strict (70-110 mg/dL). The primary aim of this trial it to demonstrate that permissive intrapartum glucose management is not associated with an increased risk of neonatal dysglycemia compared with strict intrapartum glucose management.
Detailed description
Type 1 Diabetes (T1D) affects approximately 0.5% of pregnancies in the US. Infants born to individuals with T1D are at increased risk of adverse pregnancy outcomes due to lack of glycemic control. Individuals with T1D are increasingly using hybrid closed loop therapy (HCL) for insulin delivery to achieve glycemic control. Current data highlight that less permissive intrapartum (while in labor) glycemic control is not associated with a increased risk of adverse pregnancy outcomes, including neonatal hypoglycemia and NICU admission. However, such data about permissive versus strict intrapartum glucose management has primarily been from pregnant individuals with type 2 diabetes or gestational diabetes who did not use HCL based insulin therapy. Pregnant individuals with diabetes who use HCL with continuous glucose monitoring and closed loop insulin delivery represent a unique population, and data from this population are needed to inform intrapartum obstetric management. The investigators hypothesize that permissive intrapartum glucose management using continuous glucose monitoring (70-140 mg/dL) will not be associated with neonatal dysglycemia measured as first mean neonatal glucose value within the first two hours of life compared with strict intrapartum glucose management or the current standard of care (70-110 mg/dL). The investigators will conduct a single center non-inferiority randomized controlled trial of permissive intrapartum glucose management (intervention) versus strict intrapartum glucose management (standard of care) among pregnant individuals with T1D using HCL who are admitted for labor management. The primary aim of this trial it to demonstrate that permissive intrapartum glucose management is not associated with an increased risk of neonatal dysglycemia (first neonatal blood glucose measured within 2 hours of life) compared with strict intrapartum glucose management. The investigators will secondarily examine the association between permissive versus strict intrapartum glucose with adverse neonatal outcomes, including neonatal hypoglycemia, neonatal hyperbilirubinemia, and NICU admission, patient satisfaction, and continuous glucose monitor (CGM) metrics.
Interventions
- Drug Insulin
Participants will be randomized in a 1:1 fashion to one of two intrapartum glycemic control options: permissive (70-140 mg/dL) or strict (70-110 mg/dL). Participants and clinicians will be unblinded. Once randomized, an order set will be entered into the EMR that will alert pharmacy and nursing colleagues to the appropriate intrapartum glycemic control protocol. - Device DEXCOM Continuous Glucose Monitor
Patients will be asked to wear an optional Continuous Glucose Monitor (CGM) to utilize during labor for research purposes. The CGM will be removed prior to hospital discharge and data will be extracted by trained research personnel. All participants already utilize a CGM device as part of standard of care as part of Hybrid Closed Loop (HCL) therapy. No clinical decisions will be made based upon data from the research CGM device. This data will not be extracted until after hospital discharge.
Primary outcome measures
- Mean of first neonatal blood glucose (continuous, mean with standard deviation) [Time frame: From birth to 2 hours after birth]
Secondary outcome measures (7)
- Neonatal C-peptide (continuous, mean with standard deviation) [Time frame: At birth]
- Neonatal hypoglycemia [Time frame: At birth, up to 24 hours]
- Neonatal hyperbilirubinemia [Time frame: Within the first 48 hours after birth]
- NICU admission [Time frame: Within the first 48 hours after birth]
- Birth experience satisfaction per Birth Satisfaction Survey-Revised (BSS-R) (continuous, mean with standard deviation) [Time frame: Day 1 through study completion (at hospital discharge), up to 4 weeks]
- Maternal IV insulin maximum dose and duration [Time frame: Day 1 through study completion, up to 4 weeks]
- Maternal Hypoglycemia [Time frame: Day 1 through study completion, up to 4 weeks]
Eligibility criteria
Inclusion criteria
- Pregnant individuals
- ≥ 18 years old
- Type 1 diabetes
- Intention for vaginal delivery and admitted to Labor and Delivery
- Singleton, non-anomalous fetus
- Gestational age greater than or equal to 35 weeks gestation.
- Cervical dilation is less than 6 cm.
- Delivering at the study institution
Exclusion criteria
- Scheduled cesarean delivery
- Cervical dilation ≥ 6 cm on presentation to L\&D
- Receipt of antenatal corticosteroids within 7 days of randomization
- Fetal demise
- Major fetal anomaly (attached)
- Multiple gestation
- Non-English speaking
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Open label
- Primary purpose
- Treatment
Study locations
United States · 1 center
- The Ohio State University Wexner Medical Center OB/GYN Maternal and Fetal Medicine — Columbus
Identifiers
NCT: NCT07293715 · STUDY 20252532