Is There a Difference in Pregnancy and Glycemic Outcome in Patients with Type 1 Diabetes on Insulin Pump with Constant or Intermittent Glucose Monitoring? A Pilot Study (original) (raw)
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Pregnancy, Diabetes, Insulin pump and CGM
Background: The aim of the study is to describe glycemic and insulin outcomes by trimester and maternal and fetal outcome in patients with type 1 diabetes using an insulin pump with constant or intermittent continuous glucose monitoring (CGM). Methods: Twenty-five women with type 1 diabetes with newly diagnosed pregnancy were treated with insulin pump therapy (Medtronic 722, Medtronic Minimed, Northridge, CA) for at least 1 year. Insulin pump and CGM (Medtronic Paradigm Real-Time) were implemented at least 3 months before conception. Patients were randomized in two groups: constant CGM group, 12 patients on insulin pump with glucose sensor, 24 h/day; and intermittent CGM group, 13 patients on insulin pump with intermittent glucose sensor, 14 days/month. The following parameters were analyzed: glycosylated hemoglobin (HbA1c), mean blood glucose, insulin requirement (in IU/kg/day), weight gain, severe hypoglycemic events, diabetic ketoacidosis, macrosomia, cesarean section, and neonatal hypoglycemia. Results: Both groups achieved good glucose control during their pregnancies (P < 0.05): 6.78 -1.3% and 6.92 -0.9% at the beginning of the study compared with 6.14 -0.9% (constant CGM group) and 6.23 -0.6% (intermittent CGM group) at the end of the study (last HbA1c before delivery). There was no significant decrease of HbA1c between the two groups. The constant CGM group had a significantly lower A1c in the first trimester compared with the intermittent CGM group. Maternal and fetal outcome did not show a significant difference between the two groups. Conclusions: Insulin pump therapy together with constant or intermittent CGM can improve diabetes control and pregnancy outcome in type 1 diabetes. The quality of the glucose profile at conception was the important factor for pregnancy outcome.
Continuous glucose monitoring‐enabled insulin‐pump therapy in diabetic pregnancy
Acta Obstetricia et Gynecologica Scandinavica, 2010
We describe the feasibility of continuous glucose monitoring (CGM)‐enabled insulin‐pump therapy during pregnancy in a woman with type 1 diabetes, who was treated with CGM‐enabled insulin‐pump therapy in her third pregnancy. During her first pregnancy, the woman was treated with multiple daily injections and baseline HbA1c was 8.9%. Due to pre‐eclampsia, the child was born preterm, and had neonatal hypoglycemia. In the planning of the second pregnancy, insulin‐pump therapy was initiated, resulting in an HbA1c of 6.8% in early pregnancy. Due to pre‐eclampsia, the second child was born preterm, but without neonatal morbidity. Before her third pregnancy, CGM‐enabled insulin‐pump therapy was introduced, and HbA1c was 6.4% in early pregnancy. The patient was satisfied with this therapy, pre‐eclampsia did not occur, and the child was born at term without neonatal morbidity. CGM‐enabled insulin‐pump therapy appears feasible in diabetic pregnancies.
Acta Diabetologica, 2003
We evaluated the outcome of pregnancies followed between 1990 and 2000 in 93 women with type 1 diabetes, treated with conventional intensive insulin therapy (n=68) or continuous subcutaneous insulin infusion (n=25). We evaluated metabolic control (fasting and 1-hour post-prandial plasma glucose and HbA1c levels), spontaneous or induced abortions, time and mode of delivery, maternal outcome (pregnancy-induced hypertension, preeclampsia, placental insufficiency, hydramnios, hypoglycemic coma, ketoacidosis) and fetal outcome (weight, hypoglycemia, hypocalcemia, hyperbilirubinemia, fetal distress, asphyxia, hyaline membrane disease, polycythemia, shoulder dystocia, malformations). Patients treated with insulin pump more frequently had background retinopathy and clinical neuropathy. No significant differences were observed between the two groups in metabolic control and maternal outcome. Glycemic control, non-optimal in the prepregnancy state, improved significantly during pregnancy, as shown by the progressive reduction in HbA1c levels. As regards fetal outcome, no differences were observed between the two groups in morbidity and especially in malformation rate. Patients with malformed babies did not have optimal metabolic control at conception. Thus, maternal and perinatal outcomes were comparable in patients treated with insulin pump and continuous subcutaneous insulin therapy, and depended on metabolic control. In patients in higher White's class and with more unstable glycemia, we achieved metabolic control and outcomes comparable with those of women of lower White's class and more stable glycemic values using the insulin pump. Our data suggest that insulin pump therapy is useful in problematic, complicated cases of women who want a baby.
Polish Archives of Internal Medicine, 2015
INTRODUCTION An adverse intrauterine environment in early pregnancy in women with type 1 diabetes is associated with several perinatal complications including spontaneous abortions, fetal congenital defects, and preeclampsia. ObjECTIvEs We compared metabolic parameters in the first trimester of pregnancy between women with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) and those treated with multiple daily injections (MDI). PATIENTs AND mEThODs A total of 168 women in the first trimester of pregnancy (33 using CSII and 135 using MDI) were enrolled in this cross-sectional single-center study. Anthropometric parameters, fasting serum levels of hemoglobin A 1c (HbA 1c), lipid profile, and estimated glucose disposal rate (eGDR) were determined. REsULTs Patients did not differ in gestational or maternal age, diabetes duration, and the frequency of planned pregnancies. Women using CSII before pregnancy had lower body mass index and waist-to-hip ratio than those using MDI (22.3 vs 23.3 and 0.77 vs 0.79, respectively, P = 0.01). A similar number of women had hypertension; however, the CSII group had lower diastolic blood pressure (P = 0.02). Moreover, the CSII group had a significantly lower insulin requirement (0.54 vs 0.63 units/kg; P = 0.02), significantly higher eGDR (11.3 vs 10.5 mg/kg/min; P = 0.0007), and significantly lower serum triglyceride levels (53.1 vs 61.8 mg/dl; P = 0.004). In a multiple regression analysis, CSII therapy was associated with higher eGDR, lower HbA 1c , and lower serum triglyceride levels. CONCLUsIONs The use of CSII before pregnancy in patients with type 1 diabetes is associated with better metabolic profile in the first trimester.
Acta Diabetologica
Aims The effects of continuous subcutaneous insulin infusion (CSII) therapy with or without continuous glucose monitoring (CGM) on neonatal outcomes and glycemic outcomes of pregnant women with type 1 diabetes (T1D), living in Poland, were assessed. Methods This prospective observational study enrolled women with T1D (N = 481, aged 18–45 years) who were pregnant or planned pregnancy. All used CSII therapy and a subset used CGM with CSII (CSII + CGM). Neonatal outcomes (e.g., rate of large for gestational age [LGA] delivery [birth weight > 90th percentile]) and maternal glycemia (e.g., HbA1c and percentage of time at sensor glucose ranges) were evaluated. Results Overall HbA1c at trimesters 1, 2, and 3 was 6.8 ± 1.1% (50.9 ± 12.3 mmol/mol, N = 354), 5.8 ± 0.7% (40.1 ± 8.0 mmol/mol, N = 318), and 5.9 ± 0.7% (41.4 ± 8.0 mmol/mol, N = 255), respectively. A HbA1c target of < 6.0% (42 mmol/mol) at each trimester was achieved by 20.9% (74/354), 65.1% (207/318), and 58.0% (148/255), r...
Diabetes care, 2018
To compare glycemic control, quality of life, and pregnancy outcomes of women using insulin pumps and multiple daily injection therapy (MDI) during the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT). This was a prespecified analysis of CONCEPTT involving 248 pregnant women from 31 centers. Randomization was stratified for pump versus MDI and HbA. The primary outcome was change in HbA from randomization to 34 weeks' gestation. Key secondary outcomes were continuous glucose monitoring (CGM) measures, maternal-infant health, and patient-reported outcomes. At baseline, pump users were more often in stable relationships ( = 0.003), more likely to take preconception vitamins ( = 0.03), and less likely to smoke ( = 0.02). Pump and MDI users had comparable first-trimester glycemia: HbA 6.84 ± 0.71 vs. 6.95 ± 0.58% (51 ± 7.8 vs. 52 ± 6.3 mmol/mol) ( = 0.31) and CGM time in target (51 ± 14 vs. 50 ± 13%) ( = 0.40). At 34 weeks, MDI users had a greater decrease ...
BMC pregnancy and childbirth, 2016
Women with type 1 diabetes strive for optimal glycemic control before and during pregnancy to avoid adverse obstetric and perinatal outcomes. For most women, optimal glycemic control is challenging to achieve and maintain. The aim of this study is to determine whether the use of real-time continuous glucose monitoring (RT-CGM) will improve glycemic control in women with type 1 diabetes who are pregnant or planning pregnancy. A multi-center, open label, randomized, controlled trial of women with type 1 diabetes who are either planning pregnancy with an HbA1c of 7.0 % to ≤10.0 % (53 to ≤ 86 mmol/mol) or are in early pregnancy (<13 weeks 6 days) with an HbA1c of 6.5 % to ≤10.0 % (48 to ≤ 86 mmol/mol). Participants will be randomized to either RT-CGM alongside conventional intermittent home glucose monitoring (HGM), or HGM alone. Eligible women will wear a CGM which does not display the glucose result for 6 days during the run-in phase. To be eligible for randomization, a minimum of ...
Diabetologia
Aims/hypothesis The aim of this study was to analyse patterns of continuous glucose monitoring (CGM) data for associations with large for gestational age (LGA) infants and an adverse neonatal composite outcome (NCO) in pregnancies in women with type 1 diabetes. Methods This was an observational cohort study of 186 pregnant women with type 1 diabetes in Sweden. The interstitial glucose readings from 92 real-time (rt) CGM and 94 intermittently viewed (i) CGM devices were used to calculate mean glucose, SD, CV%, time spent in target range (3.5-7.8 mmol/l), mean amplitude of glucose excursions and also high and low blood glucose indices (HBGI and LBGI, respectively). Electronic records provided information on maternal demographics and neonatal outcomes. Associations between CGM indices and neonatal outcomes were analysed by stepwise logistic regression analysis adjusted for confounders. Results The number of infants born LGA was similar in rtCGM and iCGM users (52% vs 53%). In the combined group, elevated mean glucose levels in the second and the third trimester were significantly associated with LGA (OR 1.53, 95% CI 1.12, 2.08, and OR 1.57, 95% CI 1.12, 2.19, respectively). Furthermore, a high percentage of time in target in the second and the third trimester was associated with lower risk of LGA (OR 0.96, 95% CI 0.94, 0.99 and OR 0.97, 95% CI 0.95, 1.00, respectively). The same associations were found for mean glucose and for time in target and the risk of NCO in all trimesters. SD was significantly associated with LGA in the second trimester and with NCO in the third trimester. Glucose patterns did not differ between rtCGM and iCGM users except that rtCGM users had lower LBGI and spent less time below target. Conclusions/interpretation Higher mean glucose levels, higher SD and less time in target range were associated with increased risk of LGA and NCO. Despite the use of CGM throughout pregnancy, the day-today glucose control was not optimal and the incidence of LGA remained high.