Insulin pump use in pregnancy is associated with lower HbA1c without increasing the rate of severe hypoglycaemia or diabetic ketoacidosis in women with type 1 diabetes

Kallas-Koeman, Melissa M.; Kong, Jason M.; Klinke, Jennifer A.; Butalia, Sonia; Lodha, Abhay; Lim, Kenneth; Duan, Qiuli; Donovan, Lois

doi:10.1007/s00125-014-3163-6

Cited by 78 publications

(74 citation statements)

References 32 publications

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“…The outcome of such a high-risk pregnancy is not easy to predict. A recent multicenter study in women using insulin pumps during pregnancy, just like in our small group, indicated a lower HbA1c without an increased risk of severe hypoglycemia 22 . All the patients wore insulin pump before becoming pregnant and started their pregnancy well prepared (were well educated and informed about lower targets).…”

Section: Discussionsupporting

confidence: 59%

Nocturnal Hypoglycemia – The Main Indication for Insulin Pump Therapy in Adulthood

Baretić

Kraljević

Renar

2016

ACC

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SUMMARY -The aim was to determine which adult type 1 diabetic patient receiving multiple daily injection therapy is the most appropriate candidate for insulin pump therapy, while taking into consideration limited insulin pump affordability in Croatia. A total of 145 type 1 diabetic patients (52% diagnosed in adult age) were monitored at the Department of Endocrinology, Clinical Department of Internal Medicine, Zagreb University Hospital Center from 2009 to 2014. Twenty-one patients started insulin pump therapy in adulthood (seven men and 14 women, median age 27). Five patients had chronic complications (retinopathy in two, polyneuropathy in one, and both nephropathy and retinopathy in two patients). The median HbA1c at the initiation of pump therapy was 6.95% versus 6.5% after 1 year of pump therapy. Patients were stratified according to indications for insulin pump therapy (frequent and/or severe hypoglycemia, specific lifestyle, having not reached glycemic goals despite adherence/labile diabetes, and preconception). Patients could meet more than one criterion. Initially, the occurrence of hypoglycemia was analyzed by 6-day continuous glucose monitoring, while re-evaluation was done after collecting history data at 1 year ± 3 months. Initially, all patients had a median of 5 hypoglycemias/6 days (30% nocturnal) versus 1 hypoglycemia/6 days (without nocturnal) after 1 year. The Wilcoxon signed-rank test yielded a statistically significant difference in hypoglycemic events, nocturnal hypoglycemia and HbA1c. Patients commencing insulin pump therapy due to hypoglycemia initially had median HbA1c of 6.7% with 7 hypoglycemia/6 days (50% nocturnal). After one year, median HbA1c was 6% with 1 hypoglycemia/6 days (without nocturnal). In conclusion, the main indication for insulin pump therapy in adults is the frequency of hypoglycemia, especially nocturnal ones.

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Section: Discussionsupporting

confidence: 59%

Nocturnal Hypoglycemia – The Main Indication for Insulin Pump Therapy in Adulthood

Baretić

Kraljević

Renar

2016

ACC

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“…This study was performed using data collected for a previous retrospective observational cohort analysis examining insulin pump use in pregnancy [17].…”

Section: Study Populationmentioning

confidence: 99%

Large‐for‐gestational‐age (LGA) neonate predicts a 2.5‐fold increased odds of neonatal hypoglycaemia in women with type 1 diabetes

Yamamoto

Kallas-Koeman

Butalia

et al. 2016

Diabetes Metabolism Res

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Objective The objective of the study is to assess the impact of maternal glycaemic control and large-for-gestational-age (LGA) infant size on the risk of developing neonatal hypoglycaemia in offspring of women with type 1 diabetes and to determine possible predictors of neonatal hypoglycaemia and LGA.Research methods and design This retrospective cohort study evaluated pregnancies in 161 women with type 1 diabetes mellitus at a large urban centre between 2006 and 2010. Mean trimester A 1c values were categorized into five groups. Multiple logistic regression analyses were used to examine predictors of neonatal hypoglycaemia and large-for-gestational-age (LGA).Results Hypoglycaemia occurred in 36.6% of neonates. There was not a linear association between trimester specific A 1c and LGA. After adjusting for maternal age, body mass index (BMI), smoking and premature delivery, neonatal hypoglycaemia was not linearly associated with A 1c in the first, second or third trimesters.LGA was the only significant predictor for neonatal hypoglycaemia (OR, 95% CI 2.51 [1.10, 5.70]) in logistic regression analysis that adjusted for glycaemic control, maternal age, smoking, prematurity and BMI. An elevated third trimester A 1c increased the odds of LGA (1.81 [1.03, 3.18]) after adjustment for smoking, parity and maternal BMI.Conclusions Large-for-gestational-age imparts a 2.5-fold increased odds of hypoglycaemia in neonates of women with type 1 diabetes and may be a better predictor of neonatal hypoglycaemia than maternal glycaemic control. Our data suggest that LGA neonates of women with type 1 diabetes should prompt increased surveillance for neonatal hypoglycaemia and that the presence of optimum maternal glycaemic control should not reduce this surveillance.

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“…All study centers used the same devices and the same methods of education and training for participants. However, a limitation was that, although studies comparing the use of CSII and MDI have yielded inconsistent results [23,29,[42][43][44][45][46], it was not possible to compare the results of pump use with a control group not using pump therapy and/or pump therapy supported by CGM. Nevertheless, this study offered a unique opportunity to follow a large patient population using standardized insulin-delivery devices to assess the prevalence of pregnancy complications and outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, insulin pump use in pregnancy has been found to reduce HbA 1c levels in patients with T1DM without increasing the rate of severe hypoglycemia or ketoacidosis [23]. Both CSII and continuous glucose monitoring (CGM), alone or in combination as a sensor-augmented pump (SAP) or sensor-integrated pump (SIP) therapy, improve glycemic control by reducing HbA 1c from 0.4-1.2% [24][25][26][27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

Objectives and methods of the ORCHESTRA FOUNDATION Registry study: a multicenter observational study of the use of insulin pump therapy in pregnant women with type 1 diabetes mellitus in Poland.

Sieradzki¹,

Cyganek²,

Cypryk³

et al. 2018

Clinical Diabetology

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Insulin pump use in pregnancy is associated with lower HbA1c without increasing the rate of severe hypoglycaemia or diabetic ketoacidosis in women with type 1 diabetes

Cited by 78 publications

References 32 publications

Nocturnal Hypoglycemia – The Main Indication for Insulin Pump Therapy in Adulthood

Nocturnal Hypoglycemia – The Main Indication for Insulin Pump Therapy in Adulthood

Large‐for‐gestational‐age (LGA) neonate predicts a 2.5‐fold increased odds of neonatal hypoglycaemia in women with type 1 diabetes

Objectives and methods of the ORCHESTRA FOUNDATION Registry study: a multicenter observational study of the use of insulin pump therapy in pregnant women with type 1 diabetes mellitus in Poland.

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