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Levy CJ, Foster NC, DuBose SN, Agarwal S, Lyons SK, Peters AL, Uwaifo GI, DiMeglio LA, Sherr JL, Polsky S. Changes in Device Uptake and Glycemic Control Among Pregnant Women With Type 1 Diabetes: Data From the T1D Exchange. J Diabetes Sci Technol 2021; 15:1297-1302. [PMID: 33218278 PMCID: PMC8655289 DOI: 10.1177/1932296820972123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To examine changes in device use and glycemic outcomes for pregnant women from the T1D Exchange Clinic Registry between the years 2010-2013 and 2016-2018. METHODS Participant-reported device use and glycemic outcomes were compared for women aged 16-40 years who were pregnant at the time of survey completion, comparing 2010-2013 (cohort 1) and 2016-2018 (cohort 2). Hemoglobin A1c results within 30 days prior to survey completion were obtained from medical records. RESULTS There were 208 pregnant women out of 5,236 eligible participants completing the questionnaire in cohort 1 and 47 pregnant women out of 2,818 eligible participants completing the questionaire in cohort 2. Continuous glucose monitor (CGM) use while pregnant trended upward among cohort 2 (70% vs 37%, P = .02), while reported continuous subcutaneous insulin infusion (CSII) use while pregnant declined (76% vs 64%, P = .04). HbA1c levels trended downward (6.8% cohort 1 vs 6.5% cohort 2, P = .07). CONCLUSIONS Self-reported CGM use while pregnant increased over the studied intervals whereas CSII use decreased. Additional evaluation of device use and the potential benefits for T1D pregnancies is needed.
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Affiliation(s)
| | - Nicole C. Foster
- Jaeb Center for Health Research, Tampa,
FL, USA
- Nicole C. Foster, MS, Jaeb Center for Health
Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647, USA.
| | | | - Shivani Agarwal
- Fleischer Institute of Diabetes and
Metabolism, Center for Diabetes Translational Research, Albert Einstein College of
Medicine, Bronx, NY, USA
| | - Sarah K. Lyons
- Baylor College of Medicine, Texas
Children’s Hospital, Houston, TX, USA
| | - Anne L. Peters
- Keck School of Medicine of the
University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Sarit Polsky
- Barbara Davis Center for Diabetes,
Aurora, CO, USA
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Buschur EO, Campbell K, Pyle L, Garcetti R, Joshee P, Demmitt JK, Snell-Bergeon JK, Polsky S. Exploratory Analysis of Glycemic Control and Variability Over Gestation Among Pregnant Women with Type 1 Diabetes. Diabetes Technol Ther 2021; 23:768-772. [PMID: 34115946 PMCID: PMC9009588 DOI: 10.1089/dia.2021.0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In exploratory analyses, we evaluated glycemic variability (GV) and gestational outcomes in pregnant women (n = 28) with type 1 diabetes (T1D). Gestational age at delivery was higher for women with lower glycemic measures, including estimated HbA1c (eHbA1c) (0.14% decrease in HbA1c per 1-week greater gestational age, P = 0.0035), mean sensor glucose (-3.9 mg/dL P = 0.0039), time spent >140 mg/dL (-3.1%, P = 0.0029), and higher time in range (TIR) of 63-140 mg/dL (3.2%, P = 0.0029). Third trimester measured HbA1c was significantly associated with gestational age at delivery (P = 0.0081). Preeclampsia was associated with less TIR in first (50.5% vs. 69.9%, P = 0.0034) and second trimesters (47.1% vs. 66.7%, P = 0.0025), but not with measured HbA1c. There were significant differences in other markers of GV (continuous overall net glycemic action, high blood glucose index, J-index, mean amplitude of glycemic excursions) with infant birth weight and gestational age at delivery. Thus, multiple markers of glycemia and GV were associated with gestational health outcomes in T1D pregnancies in this pilot study. Clinical Trial Registration number: NCT02556554.
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Affiliation(s)
- Elizabeth O. Buschur
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kristen Campbell
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel Garcetti
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Prakriti Joshee
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Jamie K. Demmitt
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Janet K. Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
- Address correspondence to: Sarit Polsky, MD, MPH, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
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Buschur EO, Polsky S. Type 1 Diabetes: Management in Women From Preconception to Postpartum. J Clin Endocrinol Metab 2021; 106:952-967. [PMID: 33331893 DOI: 10.1210/clinem/dgaa931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 01/11/2023]
Abstract
CONTEXT This review presents an up-to-date summary on management of type 1 diabetes mellitus (T1DM) among women of reproductive age and covers the following time periods: preconception, gestation, and postpartum. EVIDENCE ACQUISITION A systematic search and review of the literature for randomized controlled trials and other studies evaluating management of T1DM before pregnancy, during pregnancy, and postpartum was performed. EVIDENCE SYNTHESIS Preconception planning should begin early in the reproductive years for young women with T1DM. Preconception and during pregnancy, it is recommended to have near-normal glucose values to prevent adverse maternal and neonatal outcomes, including fetal demise, congenital anomaly, pre-eclampsia, macrosomia, neonatal respiratory distress, neonatal hyperbilirubinemia, and neonatal hypoglycemia. CONCLUSION Women with T1DM can have healthy, safe pregnancies with preconception planning, optimal glycemic control, and multidisciplinary care.
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Affiliation(s)
| | - Sarit Polsky
- The University of Colorado Barbara Davis Center, Denver, CO, USA
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Gyselaers W, Lanssens D, Perry H, Khalil A. Mobile Health Applications for Prenatal Assessment and Monitoring. Curr Pharm Des 2020; 25:615-623. [PMID: 30894100 DOI: 10.2174/1381612825666190320140659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND A mobile health application is an exciting, fast-paced domain that is likely to improve prenatal care. METHODS In this narrative review, we summarise the use of mobile health applications in this setting with a special emphasis on both the benefits of remote monitoring devices and the potential pitfalls of their use, highlighting the need for robust regulations and guidelines before their widespread introduction into prenatal care. RESULTS Remote monitoring devices for four areas of prenatal care are reported: (1) cardio-tocography; (2) blood glucose levels; (3) blood pressure; and (4) prenatal ultrasound. The majority of publications are pilot projects on remote consultation, education, coaching, screening, monitoring and selective booking, mostly reporting potential medical and/or economic benefits by mobile health applications over conventional care for very specific situations, indications and locations, but not always generalizable. CONCLUSIONS Despite the potential advantages of these devices, some caution must be taken when implementing this technology into routine daily practice. To date, the majority of published research on mobile health in the prenatal setting consists of observational studies and there is a need for high-quality randomized controlled trials to confirm the reported clinical and economic benefits as well as the safety of this technology. There is also a need for guidance and governance on the development and validation of new apps and devices and for the implementation of mobile health technology into healthcare systems in both high and low-income settings. Finally, digital communication technologies offer perspectives towards exploration and development of the very new domain of tele-pharmacology.
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Affiliation(s)
- Wilfried Gyselaers
- Department of Obstetrics, Ziekenhuis Oost-Limburg, Genk, Belgium; 2Department of Physiology, Hasselt University, Hasselt, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
| | - Dorien Lanssens
- Department of Physiology, Hasselt University, Hasselt, Belgium.,Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Helen Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom
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Linden K, Berg M, Adolfsson A, Sparud‐Lundin C. Person-centred, web-based support in pregnancy and early motherhood for women with Type 1 diabetes mellitus: a randomized controlled trial. Diabet Med 2018; 35:232-241. [PMID: 29171071 PMCID: PMC5814869 DOI: 10.1111/dme.13552] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 12/11/2022]
Abstract
AIMS To report results from and explore use of a multicentre, parallel-group, unblinded, randomized controlled trial testing the effectiveness in terms of well-being and diabetes management of a person-centred, web-based support programme for women with Type 1 diabetes, in pregnancy and postpartum. METHODS Between 2011 and 2014, 174 pregnant women with Type 1 diabetes were randomly allocated (1:1) to web-based support and standard care (intervention group, n=83), or standard care (control group, n=91). The web-based support consisted of evidence-based information; a self-care diary for monitoring of daily activities; and peer support in a discussion forum. The primary outcomes (mean difference, measured at 6 months after childbirth) were well-being and diabetes management. RESULTS No differences were found with regard to the primary outcome measure scores for general well-being [1.04 (95% CI -1.28 to 3.37); P=0.68] and self-efficacy of diabetes management [0.08 (95% CI -0.12 to 0.28); P= 0.75], after adjustment for baseline differences in the insulin administration method, nor with regard to the secondary outcome measures. CONCLUSIONS At 6 months after childbirth, the web-based support plus standard care was not superior to standard care in terms of general well-being or self-efficacy of diabetes management. This might be explained by the low number of participants who had a high activity level. Few simultaneously active participants in the web-based programme and stressors in motherhood and diabetes postpartum were the main barriers to its use. Further intervention studies that offer web-based support are needed, with lessons learned from the present study. (Clinicaltrials.gov identification number: NCT015665824).
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Affiliation(s)
- K. Linden
- Centre for Person‐Centred CareInstitute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - M. Berg
- Centre for Person‐Centred CareInstitute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Obstetrics and GynecologySahlgrenska University HospitalGothenburgSweden
| | - A. Adolfsson
- School of Medical SciencesÖrebro UniversityÖrebroSweden
- Faculty of Health SciencesDepartment of Nursing ScienceUniversity College of Southeast NorwayKongsbergNorway
| | - C. Sparud‐Lundin
- Centre for Person‐Centred CareInstitute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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Abstract
Type 1 diabetes is a challenging illness and needs lifelong diabetes self-care. At the same time, there is a significant stigma associated with it, especially with relation to marriage. There are concerns related to premarriage disclosure, marital relationship, ability to procreate, risk during pregnancy in women, and the risk of disease in children. In this document, we discuss the issue of disease-related stigma which may become a significant challenge for a prospective spouse and the impact of type 1 diabetes on marital relationships and procreation. We also highlight the need for premarriage counseling to ensure long-term success in achieving both individual and interpersonal well-being.
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Affiliation(s)
- Gagan Priya
- Department of Endocrinology, Fortis Hospital, Karnal, Haryana, India
| | - Bharti Kalra
- Department of Gynaecology, Bharti Hospital, Karnal, Haryana, India
| | - Emmy Grewal
- Department of Endocrinology, Ivy Hospital, Mohali, India
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F Carbonel AA, Azevedo Lima PD, Lim JJ, Teixeira Borges F, Rodrigues da Silva Sasso G, Portugal Fuchs LF, S Simões R, Chada Baracat E, Soares JM, J Simões M. Effects of soy isoflavones on the concentration of hyaluronic acid in the vagina of type 1 diabetic rats. Climacteric 2017; 20:564-570. [PMID: 28866964 DOI: 10.1080/13697137.2017.1366977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the effects of isoflavones and 17β-estradiol on the vaginal epithelium extracellular matrix and hyaluronic acid (HA) in the diabetic rat model. METHODS Sixty adult, virgin, female rats underwent ovariectomy, then randomization into six groups of ten animals each: GI, sham ovariectomized control animals; GII, sham ovariectomized control diabetic animals; GIII, control ovariectomized rats receiving propylene glycol vehicle; GIV, control ovariectomized diabetic animals receiving propylene glycol vehicle; GV, diabetic ovariectomized animals treated with soy isoflavones (150 mg/kg by gavage); GVI, ovariectomized diabetic rats treated with estrogen (17β-estradiol, 10 mg/kg, subcutaneously). Treatment took place over 30 consecutive days. After euthanasia, a portion of the vagina was immersed in liquid nitrogen for RT-qPCR and Western blotting. Another portion was processed for paraffin embedding. Sections were stained with hematoxylin & eosin for histomorphometry and Picro Sirius Red for collagen quantification. RESULTS Vaginal epithelium histomorphometry in GIII (15.3 ± 1.1 µm) and GIV (14.5 ± 1.8 µm) was thinner than in GV (41.3 ± 1.5 µm) and GVI (74.3 ± 1.6 µm). There was an increase in collagen content in GV (84.1 ± 1.2 µm) and GVI (88.2 ± 1.7 µm). HA quantification was higher in GV (0.38 ± 1.1 μg/mg) and GVI (0.49 ± 1.4 μg/mg) when compared with GIII (0.12 ± 1.1 μg/mg) and GIV (0.10 ± 1.2 μg/mg), p < 0.05. CONCLUSIONS Soy isoflavones increase hyaluronic acid concentration in the vagina of diabetic ovariectomized rats. Such findings might help to attenuate the effects of vulvovaginal atrophy in women.
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Affiliation(s)
- A A F Carbonel
- a Department of Morphology and Genetics , Paulista School of Medicine/Federal University of São Paulo, EPM/UNIFESP , São Paulo , Brazil
| | - P D Azevedo Lima
- b Department of Cellular and Molecular Medicine , University of Ottawa , Ottawa , Canada
| | - J J Lim
- b Department of Cellular and Molecular Medicine , University of Ottawa , Ottawa , Canada
| | - F Teixeira Borges
- c Department of Nephrology , Paulista School of Medicine/Federal University of São Paulo, EPM/UNIFESP , São Paulo , Brazil
| | - G Rodrigues da Silva Sasso
- a Department of Morphology and Genetics , Paulista School of Medicine/Federal University of São Paulo, EPM/UNIFESP , São Paulo , Brazil
| | - L F Portugal Fuchs
- d Department of Obstetrics and Gynecology , Medicine Faculty of University of São Paulo, FMUSP , São Paulo , Brazil
| | - R S Simões
- d Department of Obstetrics and Gynecology , Medicine Faculty of University of São Paulo, FMUSP , São Paulo , Brazil
| | - E Chada Baracat
- d Department of Obstetrics and Gynecology , Medicine Faculty of University of São Paulo, FMUSP , São Paulo , Brazil
| | - J M Soares
- d Department of Obstetrics and Gynecology , Medicine Faculty of University of São Paulo, FMUSP , São Paulo , Brazil
| | - M J Simões
- a Department of Morphology and Genetics , Paulista School of Medicine/Federal University of São Paulo, EPM/UNIFESP , São Paulo , Brazil
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Gómez AM, Marín Carrillo LF, Arévalo Correa CM, Muñoz Velandia OM, Rondón Sepúlveda MA, Silva Herrera JL, Henao Carrillo DC. Maternal-Fetal Outcomes in 34 Pregnant Women with Type 1 Diabetes in Sensor-Augmented Insulin Pump Therapy. Diabetes Technol Ther 2017; 19:417-422. [PMID: 28731823 DOI: 10.1089/dia.2017.0030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pregnancy in women with type 1 diabetes (T1D) is associated with increased risk of maternal complications and neonatal morbidity and mortality. Optimizing glycemic control improves these outcomes. OBJECTIVE To describe the experience of using sensor-augmented insulin pump therapy (SAPT) and SAPT + low-glucose suspension (LGS) on pregnant women with T1D, including neonatal and maternal outcomes. METHODS A prospective observational study was conducted in women with T1D who started SAPT and SAPT + LGS before or during pregnancy at the San Ignacio University Hospital Diabetes Center in Bogotá, Colombia. The main indication was severe hypoglycemia (SH) and poor glycemic control. Glycated hemoglobin (A1c), hypoglycemia, and maternal and fetal outcomes were assessed. RESULTS Thirty-four pregnant women with T1D on SAPT and SAPT + LGS were included. Sixteen patients started therapy during pregnancy at a mean gestational age of 17.6 ± 8.3 weeks. Mean preconceptional A1c was 8.24% ± 2.02%. Absolute reduction of A1c level from prepregnancy to third trimester was -1.63% (P < 0.0001), with a significant clinical and statistical reduction in both groups, women who initiated SAPT before or during pregnancy. 52.9% of patients in second trimester and 66.6% in third trimester achieved A1c <6.5%, respectively. 91.1% underwent cesarean section. The main reasons were iterative cesarean (30%), fetal distress (20%), and preeclampsia (16%). The median gestational age at delivery was 37 weeks and 15 pregnancies resulted in preterm delivery. There was neither maternal-fetal mortality nor severe hypoglycemic episodes. Two patients had diabetic ketoacidosis. CONCLUSIONS In pregnant patients with T1D and high risk of hypoglycemia, SAPT and SAPT + LGS should be considered as a therapeutic alternative for A1c reduction with a low risk of SH. However, additional studies are required to evaluate the efficacy and safety of this therapy during pregnancy.
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Affiliation(s)
- Ana María Gómez
- 1 Division of Endocrinology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio , Bogotá, Colombia
| | | | - Carol M Arévalo Correa
- 1 Division of Endocrinology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio , Bogotá, Colombia
| | - Oscar Mauricio Muñoz Velandia
- 2 Department of Internal Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio , Bogotá, Colombia
- 3 Department of Clinical Epidemiology and Statistics, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio , Bogotá, Colombia
| | - Martín Alonso Rondón Sepúlveda
- 3 Department of Clinical Epidemiology and Statistics, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio , Bogotá, Colombia
| | - Jaime Luis Silva Herrera
- 4 Department of Gynecology and Obstetrics, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio , Bogotá, Colombia
| | - Diana Cristina Henao Carrillo
- 1 Division of Endocrinology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio , Bogotá, Colombia
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Abell SK, Suen M, Pease A, Boyle JA, Soldatos G, Regan J, Wallace EM, Teede HJ. Pregnancy Outcomes and Insulin Requirements in Women with Type 1 Diabetes Treated with Continuous Subcutaneous Insulin Infusion and Multiple Daily Injections: Cohort Study. Diabetes Technol Ther 2017; 19:280-287. [PMID: 28282241 DOI: 10.1089/dia.2016.0412] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND We aimed to compare glycemic control, insulin requirements, and outcomes in women with type 1 diabetes in pregnancy treated with continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI). METHODS A retrospective cohort study was conducted of singleton pregnancies (>20 weeks gestation) in women with type 1 diabetes (2010-2015) at a specialist multidisciplinary maternity network in Australia. Antenatal characteristics, diabetes history and treatment details, and maternal and neonatal outcomes were compared for women with type 1 diabetes using CSII and MDI. Bolus calculator settings were reviewed for CSII. Data were obtained from individual medical records, linkage to pathology, and the Birthing Outcomes System database. RESULTS There were no differences in maternal characteristics or diabetes history between women managed with CSII (n = 40) and MDI (n = 127). Women treated with CSII required less insulin and less increase in total daily insulin dose/kg than MDI (40% vs. 52%). Both groups achieved similar glycemic control and no differences in pregnancy outcome. In the CSII group, carbohydrate:insulin ratios were intensified across gestation (30% breakfast, 27% lunch, 22% dinner), and insulin sensitivity factors (ISFs) changed little (7% breakfast, 0% lunch, -10% dinner). CONCLUSIONS There was no difference in glycemic control or pregnancy outcomes in women using CSII or MDI managed in a multidisciplinary setting. Greater adjustments are needed to ISFs with CSII therapy. Overall, these data do not support recommending CSII in pregnancy with potentially higher patient and staff demands and costs and lack of improvement in HbA1c and pregnancy outcomes.
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Affiliation(s)
- Sally K Abell
- 1 Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University , Clayton, Australia
- 2 Diabetes and Vascular Medicine Unit , Monash Health, Clayton, Australia
| | - Matthew Suen
- 2 Diabetes and Vascular Medicine Unit , Monash Health, Clayton, Australia
| | - Anthony Pease
- 2 Diabetes and Vascular Medicine Unit , Monash Health, Clayton, Australia
| | - Jacqueline A Boyle
- 1 Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University , Clayton, Australia
- 3 Monash Women's Services , Monash Health, Department of Obstetrics and Gynecology, Clayton, Australia
| | - Georgia Soldatos
- 1 Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University , Clayton, Australia
- 2 Diabetes and Vascular Medicine Unit , Monash Health, Clayton, Australia
| | - John Regan
- 3 Monash Women's Services , Monash Health, Department of Obstetrics and Gynecology, Clayton, Australia
| | - Euan M Wallace
- 3 Monash Women's Services , Monash Health, Department of Obstetrics and Gynecology, Clayton, Australia
- 4 The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University , Clayton, Australia
| | - Helena J Teede
- 1 Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University , Clayton, Australia
- 2 Diabetes and Vascular Medicine Unit , Monash Health, Clayton, Australia
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