Dr. Denice Feig to Receive the Norbert Freinkel Award from the American Diabetes Association

June 7, 2021
By Krista Lamb

At the upcoming American Diabetes Association Scientific Sessions in June, Dr. Denice Feig will receive the prestigious Norbert Freinkel Award in recognition of her outstanding contributions to the field of diabetes and pregnancy.

photo of Denice FeigDr. Feig, a clinician-scientist at Mount Sinai’s Lunenfeld-Tanenbaum Research Institute and a Professor at the University of Toronto has long been a leading voice in research that looks at improving outcomes for women with diabetes during pregnancy.

In an example of serendipity, Dr. Feig did not intend to work in this field. Early in her career, she took over a practice at Mount Sinai that had a number of patients with gestational diabetes. Working with those initial women was inspiring and over time she grew her practice to include more women with gestational diabetes and those living with type 1 or type 2 diabetes during pregnancy. “I love the fact that women are so motivated to do the best thing they can for their infants,” she says of the work. “And I find it so interesting that there are two people to take care of—the mother and the fetus. And they don’t always agree in terms of how we can treat them. And the physiology is so different than outside of pregnancy. I just find it fascinating.”

As a researcher, Dr. Feig has led two large clinical trials in the area of diabetes and pregnancy. The first, the Continuous Glucose Monitoring with Type 1 Diabetes in Pregnancy Trial (CONCEPTT), looked at whether continuous glucose monitors (CGMs) worn during pregnancy improve the outcomes for women with type 1 diabetes. During pregnancy, women with this condition have to closely monitor their blood sugar levels in order to avoid potential birth defects and other pregnancy complications. Dr. Feig and her team wanted to see if wearing a CGM could help make that monitoring easier and more effective.

The CONCEPTT trial found that the use of CGM was associated with improved neonatal outcomes including fewer large babies, less neonatal hypoglycemia and less NICU admissions. The study results have led many countries to cover the cost of CGMs during pregnancy, something for which Dr. Feig is understandably proud. “I think the best part is that I feel like we’ve had an impact in practice and in the care of women.”

Her most recent clinical trial, Metformin in women with type 2 diabetes in pregnancy (MiTy): a multicentre, international, randomised, placebo-controlled trial, has been helping clinicians consider how metformin is used in women with type 2 diabetes in pregnancy.

“MiTy was a randomized trial of 500 women with type 2 diabetes in pregnancy. Adding metformin or placebo to insulin, we found a lot of maternal and neonatal benefits. Women on metformin gained less weight, they required on average of 45 units less insulin per day. They had better glycemic control and less babies were extremely large for gestational age,” Dr. Feig explains of the trial, which is spurring more investigation into how babies who received metformin in-utero develop over time.

The study also looked at a large number of women from diverse backgrounds, as well as many who came from lower socioeconomic conditions. This was a big step forward, as research often focuses on those who face the least barriers to participation, leading to a sample that is less representative of society as a whole. Dr. Feig is hopeful that this diversity in participants will allow researchers to further look at how issues like food insecurity and preconception counselling may affect participant results.

Moving forward, Dr. Feig is hopeful she can continue to find ways to help women with diabetes have easier, safer pregnancies and to improve the outcomes for their children. “We will be following the children of the MiTy mothers to see how metformin exposure in-utero affects the children in the long-term. I’m also looking forward to continuing the work in technology and applying it to both women with type one and type two,” she says. “And I think in the area of type one, the increasing use of closed loop systems is really exciting because not only does it work to improve glycemic control, but it will also take the great burden of care off these women. It really is a big burden to make sure your sugars are so incredibly tight and a big pressure knowing what you do will impact your baby. So I think the idea of both improving glycemic control and taking away the burden is really very exciting to me.”

Dr. Denice Feig will present the Norbert Freinkel Award Lecture at the 81st annual ADA Scientific Sessions, which will take place virtually from June 25 – 29.