Study finds technosphere insulin safe for managing diabetes in pregnancy

Study finds technosphere insulin safe for managing diabetes in pregnancy | Image Credit: © interstid – © interstid – stock.adobe.com.

Technosphere insulin (TI) is a safe alternative to rapid-acting insulin analogs (RAA) in pregnancy, according to a recent study published in Pregnancy.¹

Approximately 1 in 5 pregnancies worldwide are impacted by gestational diabetes mellitus (GDM), indicating rising rates. Links have been reported for the severity of hyperglycemia with fetal overgrowth and neonatal complications.² Pharmacological agents are necessary to achieve a 1-hour postprandial (PP) goal of 140 m/dL or less in many pregnant women with diabetes.¹

“Pregnancy presents unique challenges with rising insulin resistance… and progressively longer delays in both the absorption and time-to-peak concentrations of [RAAs],” wrote investigators.

Data on technosphere insulin in pregnancy

TI has been considered as an alternative for lowering PP hyperglycemia in pregnancy, but data about its use in pregnant women remains limited. Therefore, investigators provided a case series of patients using TI in pregnancy.

The first case highlighted a non-Hispanic White woman aged 38 years with type 1 diabetes (T1D) since the age of 16 years. This patient received continuous glucose monitoring (CGM), metformin 1000 mg twice daily, and glargine before sleep through an automated insulin delivery (AID) system.

TI use began in this patient at 27- to 28-weeks’ gestation, with a CGM goal of 63 to 140 mg/dL. Meals with higher simple carbohydrates had TI added to them, and TI was also used to correct for hyperglycemia.

Use of TI to correct for 1-hour post-meal hyperglycemia was effective for rapid reductions of blood sugar. The patient successfully maintained glucose under 120 mg/dL through continuous use during labor, ending in an uncomplicated spontaneous vaginal delivery.

Early pregnancy use and routine use

In the second case, a non-Hispanic White woman aged 31 years with 19 years of T1D was on AID and using TI infrequently prior to pregnancy. This patient had a time-in-range goal of 70 to 140 mg/dL, an overnight glucose goal of 70 to 110 mg/dL, and a fasting glucose goal of 70 to 150 mg/dL.

The patient increased TI use at 8 weeks’ gestation for PP hyperglycemia management, using an insulin pump for meal bonuses and TI doses to correct high blood sugar levels. TI had improved onset for reducing glucose levels compared to RAA, with the patient often requiring 4 to 8 U of TI throughout gestation.

Cases 3 and 4 highlighted the effects of routine TI use. In case 3, a non-Hispanic White woman aged 31 years received a latent autoimmune diabetes in adults diagnosis before her second pregnancy at age 29 years. She switched from using RAA and TI shortly prior to her third pregnancy.

The patient increased her TI meal dose 3- to 4-fold in the first trimester and doubled her dose in the second trimester during both her third and fourth pregnancies. Uncomplicated spontaneous vaginal deliveries occurred at 40 weeks’ gestation in both pregnancies, with no neonatal complications and infant birth weights of 4649 and 4196 g, respectively.

Case 4 and recommendations for future research

In case 4, a non-Hispanic White woman aged 39 years with nearly life-long T1D, switched from a continuous subcutaneous insulin infusion to degludec and TI when eating before pregnancy. While this patient required a repeat cesarean delivery because of a hypertensive disorder of pregnancy, no additional complications were reported.

These cases highlighted the efficacy of TI use in pregnant women with diabetes as an alternative to RAA. Investigators recommended that randomized controlled trials be conducted to compare the efficacy of these options as prandial insulin.

“Timely, future studies are critical to determine the safety of TI use in pregnancy, appropriate TI dose conversions of RAA across pregnancy given its lower bioavailability, and the efficacy of TI compared to RAA for both PP hyperglycemia and glucose corrections,” wrote investigators.

References

1. Rickert MC, Barbour LA, Bode BW, et al. Inhaled insulin in pregnancy: A case series supporting feasibility and clinical potential for pregnant people with diabetes. Pregnancy. 2025;1(5). doi:10.1002/pmf2.70065
2. Yang J, Cummings EA, O’connell C, Jangaard K. Fetal and neonatal outcomes of diabetic pregnancies. Obstet Gynecol. 2006;108:644-650. doi:10.1097/01.AOG.0000231688.08263.47