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Continuous glucose monitoring and insulin pump therapy in pregnant women with type 1 diabetes mellitus
, 12, 12, 12, 12
Affiliations- Department of Metabolic Diseases, University Hospital, Cracow, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Cracow, Poland
open access
Abstract
Objectives: We examined the impact of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring systems (CGM) during pregnancy in women with pre-gestational type 1 diabetes (T1DM) on glycemic control and subsequent adverse outcomes.
Material and methods: In this observational, one-center study we analyzed records of consecutive 109 T1DM pregnancies (2016–2017). The final analyzed group consisted of 81 singleton pregnancies who met inclusion and exclusion criteria. We searched for the association between the use of CSII with or without CGM and pregnancy planning with glycated hemoglobin A1c (HbA1c) through pregnancy and after delivery as well as maternal and infant outcomes.
Results: Patients using CSII and CGM vs CSII without CGM and MDI (multiple daily injections) users had the lowest HbA1c levels during and after pregnancy (5.3%, 5.3%, 5.2% and 5,5% in the 1st, 2nd, 3rd trimester and postpartum visit, p = 0.003, p = 0.030, p = 0.039 and p = 0.002, respectively). Patients treated with insulin pumps with CGM and additional functions of automatic insulin delivery suspension on low glucose level (SLG) or predictive low glucose suspend (PLGS) during the third trimester and after pregnancy achieved a significantly lower HbA1c than the other CSII patients. We did not find any differences between the study groups in gestational age at delivery, preterm births, birth weight or macrosomia risk. Despite very good glycemic control, the risk of macrosomia remained high (19.7%).
Conclusions: The use of pumps equipped with CGM, especially with automatic insulin delivery suspension, may improve glycemic control in pregnant T1DM women. The proportion of macrosomia remained high.
Abstract
Objectives: We examined the impact of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring systems (CGM) during pregnancy in women with pre-gestational type 1 diabetes (T1DM) on glycemic control and subsequent adverse outcomes.
Material and methods: In this observational, one-center study we analyzed records of consecutive 109 T1DM pregnancies (2016–2017). The final analyzed group consisted of 81 singleton pregnancies who met inclusion and exclusion criteria. We searched for the association between the use of CSII with or without CGM and pregnancy planning with glycated hemoglobin A1c (HbA1c) through pregnancy and after delivery as well as maternal and infant outcomes.
Results: Patients using CSII and CGM vs CSII without CGM and MDI (multiple daily injections) users had the lowest HbA1c levels during and after pregnancy (5.3%, 5.3%, 5.2% and 5,5% in the 1st, 2nd, 3rd trimester and postpartum visit, p = 0.003, p = 0.030, p = 0.039 and p = 0.002, respectively). Patients treated with insulin pumps with CGM and additional functions of automatic insulin delivery suspension on low glucose level (SLG) or predictive low glucose suspend (PLGS) during the third trimester and after pregnancy achieved a significantly lower HbA1c than the other CSII patients. We did not find any differences between the study groups in gestational age at delivery, preterm births, birth weight or macrosomia risk. Despite very good glycemic control, the risk of macrosomia remained high (19.7%).
Conclusions: The use of pumps equipped with CGM, especially with automatic insulin delivery suspension, may improve glycemic control in pregnant T1DM women. The proportion of macrosomia remained high.
Keywords
type 1 diabetes; pregnancy; continuous glucose monitoring; insulin pump; macrosomia
About this articleTitle
Continuous glucose monitoring and insulin pump therapy in pregnant women with type 1 diabetes mellitus
Journal
Issue
Article type
Research paper
Pages
675-681
Published online
2021-04-16
Page views
7582
Article views/downloads
1599
DOI
Pubmed
Bibliographic record
Ginekol Pol 2021;92(10):675-681.
Keywords
type 1 diabetes
pregnancy
continuous glucose monitoring
insulin pump
macrosomia
Authors
Izabela Lason
Katarzyna Cyganek
Przemyslaw Witek
Bartlomiej Matejko
Maciej T. Malecki
Jan Skupien
References (21)- Owens LA, Avalos G, Kirwan B, et al. ATLANTIC DIP: closing the loop: a change in clinical practice can improve outcomes for women with pregestational diabetes. Diabetes Care. 2012; 35(8): 1669–1671.
- Tennant PWG, Glinianaia SV, Bilous RW, et al. Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: a population-based study. Diabetologia. 2014; 57(2): 285–294.
- Cyganek K, Skupien J, Katra B, et al. Risk of macrosomia remains glucose-dependent in a cohort of women with pregestational type 1 diabetes and good glycemic control. Endocrine. 2017; 55(2): 447–455.
- Kelstrup L, Clausen TD, Mathiesen ER, et al. High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia. Diabetes Care. 2008; 31(2): 340–346.
- Hillier TA, Pedula KL, Schmidt MM, et al. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care. 2007; 30(9): 2287–2292.
- Rijpert M, Evers IM, de Vroede MA, et al. Risk factors for childhood overweight in offspring of type 1 diabetic women with adequate glycemic control during pregnancy: Nationwide follow-up study in the Netherlands. Diabetes Care. 2009; 32(11): 2099–2104.
- Murphy HR, Bell R, Cartwright C, et al. Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: a prospective nationwide study. Diabetologia. 2017; 60(9): 1668–1677.
- Jendle J, Smith-Palmer J, Delbaere A, et al. Cost-Effectiveness Analysis of Sensor-Augmented Insulin Pump Therapy with Automated Insulin Suspension Versus Standard Insulin Pump Therapy in Patients with Type 1 Diabetes in Sweden. Diabetes Ther. 2017; 8(5): 1015–1030.
- Feig DS, Donovan LE, Corcoy R, et al. CONCEPTT Collaborative Group. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet. 2017; 390(10110): 2347–2359.
- Broughton C, Douek I. An overview of the management of diabetes from pre-conception, during pregnancy and in the postnatal period. Clinical Medicine. 2019; 19(5): 399–402.
- American Diabetes Association. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2020. American Diabetes Association. Diabetes Care. 2020; 43(Suppl 1): S183–S192.
- Cyganek K, Hebda-Szydlo A, Katra B, et al. Glycemic control and selected pregnancy outcomes in type 1 diabetes women on continuous subcutaneous insulin infusion and multiple daily injections: the significance of pregnancy planning. Diabetes Technol Ther. 2010; 12(1): 41–47.
- 2016 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Clinical Diabetol. 2016; 5(Suppl A): A46–A48.
- 2020 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Clin Diabetol 2020; 9, 1: 64-68. doi: 10.5603/DK.2020.0001. 2020; 9(1): 64–68.
- Wender-Ożegowska E, Bomba-Opoń D, Brązert J, et al. Standards of Polish Society of Gynecologists and Obstetricians in management of women with diabetes. Ginekol Pol. 2018; 89(6): 341–350.
- Advani A. Positioning time in range in diabetes management. Diabetologia. 2020; 63(2): 242–252.
- Murphy HR, Rayman G, Lewis K, et al. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial. BMJ. 2008; 337: a1680.
- Polsky S, Garcetti R, Pyle L, et al. Continuous glucose monitor use with and without remote monitoring in pregnant women with type 1 diabetes: A pilot study. PLoS One. 2020; 15(4): e0230476.
- Jotic A, Milicic T, Lalic K, et al. Evaluation of Glycaemic Control, Glucose Variability and Hypoglycaemia on Long-Term Continuous Subcutaneous Infusion vs. Multiple Daily Injections: Observational Study in Pregnancies With Pre-Existing Type 1 Diabetes. Diabetes Ther. 2020; 11(4): 845–858.
- Hauffe F, Schaefer-Graf UM, Fauzan R, et al. Higher rates of large-for-gestational-age newborns mediated by excess maternal weight gain in pregnancies with Type 1 diabetes and use of continuous subcutaneous insulin infusion vs multiple dose insulin injection. Diabet Med. 2019; 36(2): 158–166.
- Kristensen K, Ögge LE, Sengpiel V, et al. Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies. Diabetologia. 2019; 62(7): 1143–1153.
