14. Management of Diabetes in Pregnancy: <i>Standards of Medical Care in Diabetes—2019</i>

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doi:10.2337/dc19-s014

Cited by 235 publications

(109 citation statements)

References 89 publications

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“…On this research use of aspirin was not studied, but we assume that it was prescribed to all patients who received prenatal care at our institution, since it is part of prenatal protocol in patients with T1DM. It is a consent in the medical community that low-dose aspirin should be prescribed from the end of the rst trimester until the baby is born in order to lower the risk of preeclampsia in patients with T1DM 15 . Our ndings reinforce this recommendation due to the morbidity and prevalence of preeclampsia in this population.Other important PLTC criteria were hemorrhagic complications and blood transfusions, complications than increase maternal morbidity worldwide 16 .…”

Section: Discussionmentioning

confidence: 99%

Maternal near miss and potentially life-threatening condition determinants in patients with type 1 Diabetes Mellitus in a university hospital in Sao Paulo, Brazil: a retrospective study.

Morais

Patz

Campanharo

et al. 2020

Preprint

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Background: To date, the rates of potentially life-threatening condition (PTLC), maternal near miss (MNM) and maternal deaths in pregnant patients with type 1 diabetes mellitus (T1DM) and variables associated to it have not been studied. Methods: This study was as a cross-sectional retrospective study conducted at São Paulo Hospital of Universidade Federal de São Paulo, a tertiary hospital that provides public medical care through the Brazilian unified health system to high-risk pregnancies. Inclusion criteria were T1DM pregnant women who delivered from January 2005 to December 2015. Three groups were established by the World Heath Organization criteria and associations were assessed using the chi-square test in between MNM and no morbidity or PLTC and no morbidity. A P value < 0.05 was considered statistically significant. Results: The final sample included 137 patients, 8 MNM cases (5.84%), 51 PLTC (37.23%), no cases of maternal deaths and 78 patients (56.93%) did not present any complication. Moreover, there were 122 live births, resulting in a near miss rate of 65.5 per 1.000 live births in patients with T1DM. Two of the MNM cases were for clinical criteria (uncontrollable fit in both) and laboratory criteria for the other six: one patient with severe acute azotemia (creatinine >300 μmol/ml), one patient with severe hypoperfusion (lactate >5 mmol/L) and four of them with loss of consciousness and the presence of glucose and ketoacids in urine. PLTC criteria were studied in MNM and PLTC cases. Prolonged hospital stay was the most prevalent PLTC criteria in both groups (100% of MNM cases and 96% of PLTC), followed by renal failure in 50% of MNM cases and severe preeclampsia in 22% of PLTC cases. This study could not find any association between prenatal factors or sociodemographic characteristics with maternal morbidity. Conclusions: MNM rate in T1DM was extremely high, and determined by complications of the primary disease or hypertensive disorders. No sociodemographic variables studied were related to maternal morbidity; therefore, we could not predict what increases MNM and PLTC in this specific population.

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Section: Discussionmentioning

confidence: 99%

Maternal near miss and potentially life-threatening condition determinants in patients with type 1 Diabetes Mellitus in a university hospital in Sao Paulo, Brazil: a retrospective study.

Morais

Patz

Campanharo

et al. 2020

Preprint

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“…With use of SMBG in pregnancy for over 45 years, this method remains the current standard of care for glycemic monitoring during pregnancy in the United States. 46 Guidelines on pregnancy glycemic targets in T1D have been published by the American Diabetes Association (ADA), Endocrine Society, American Association of Clinical Endocrinologists (AACE), and the National Institute for Health and Care Excellence (NICE) ( Table 1). 17,18,[20][21][22]47 Pregnant patients with T1D are instructed to test as often as 8 to 10 times daily (including pre-and post-meals, before bedtime, and overnight), in accordance with current expert guidelines.…”

Section: Current Smbg Guidelinesmentioning

confidence: 99%

“…17,18,[20][21][22]47 Pregnant patients with T1D are instructed to test as often as 8 to 10 times daily (including pre-and post-meals, before bedtime, and overnight), in accordance with current expert guidelines. 18,46,48 In addition to monitoring blood glucose trends, SMBG helps to approximate insulin requirements, particularly in the setting of glycemic variability throughout pregnancy. 24 SMBG provides an often incomplete depiction of overall glycemic profiles, and invariably, the results do not fully capture all hyper-and hypoglycemic episodes.…”

Section: Current Smbg Guidelinesmentioning

confidence: 99%

Leveraging technology for the treatment of type 1 diabetes in pregnancy: A review of past, current, and future therapeutic tools

Nosova

O’Malley

Dassau

et al. 2020

Journal of Diabetes

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The significant risks associated with pregnancies complicated by type 1 diabetes (T1D) were first recognized in the medical literature in the mid‐twentieth century. Stringent glycemic control with hemoglobin A1c (HbA1c) values ideally less than 6% has been shown to improve maternal and fetal outcomes. The management options for pregnant women with T1D in the modern era include a variety of technologies to support self‐care. Although self‐monitoring of blood glucose (SMBG) and multiple daily injections (MDI) are often the recommended management options during pregnancy, many people with T1D utilize a variety of different technologies, including continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (CSII), and CSII including automated delivery or suspension algorithms. These systems have yielded invaluable diagnostic and therapeutic capabilities and have the potential to benefit this understudied higher‐risk group. A recent prospective, multicenter study evaluating pregnant patients with T1D revealed that CGM significantly improves maternal glycemic parameters, is associated with fewer adverse neonatal outcomes, and minimizes burden. Outcome data for CSII, which is approved for use in pregnancy and has been utilized for several decades, remain mixed. Current evidence, although limited, for commercially available and emerging technologies for the management of T1D in pregnancy holds promise for improving patient and fetal outcomes.

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“…В настоящее время метформин остается препаратом первой линии для лечения СД2 как в отечественных, так и в зарубежных алгоритмах и стандартах медицинской помощи пациентам с СД [26,66,67]. Эффективность и безопасность использования метформина как в качестве монотерапии, так и в составе комбинированной терапии подтверждены многими клиническими исследованиями.…”

Section: влияние метформина на риск развития гипогликемии и когнитивнunclassified

Hypoglycemia and the risk of cognitive impairment and dementia in elderly and senile patients with type 2 diabetes

Остроумова¹,

Суркова²,

Васильевна³

et al. 2020

Diabetes mellitus

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Research results show that poor glycemic control and recurrent episodes of severe hypoglycaemia are associated with a decrease in cognitive function in elderly people with type 2 diabetes mellitus (T2DM). On the other hand, patients with diabetes mellitus associated with cognitive impairment/dementia are most at risk of developing hypoglycaemic conditions. It is obvious that the relationship between hypoglycaemia and dementia is very complex and has a mutually aggravating nature. Studies also show that individuals of older age groups with diabetes and cognitive impairment have a high risk of developing hypoglycaemic conditions, such as unwanted side effects from glucose-lowering therapy. In this case, of particular interest is the question that is being actively studied at the present time, which is concerning the effect of different groups of glucose-lowering antidiabetic drugs on the cognitive status and the rate of cognitive decline in diabetic patients with cognitive impairment. In this review, we attempted to summarise, systematise, and present data available in the literature concerning the effect of hypoglycaemia on the risk of cognitive impairment and dementia in elderly and senile patients with type-2 diabetes, as well as the degree of participation in this process of of various groups of sugar-lowering antidiabetic drugs.

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14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2019

Cited by 235 publications

References 89 publications

Maternal near miss and potentially life-threatening condition determinants in patients with type 1 Diabetes Mellitus in a university hospital in Sao Paulo, Brazil: a retrospective study.

Maternal near miss and potentially life-threatening condition determinants in patients with type 1 Diabetes Mellitus in a university hospital in Sao Paulo, Brazil: a retrospective study.

Leveraging technology for the treatment of type 1 diabetes in pregnancy: A review of past, current, and future therapeutic tools

Hypoglycemia and the risk of cognitive impairment and dementia in elderly and senile patients with type 2 diabetes

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