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Benefits, risks, costs, and patient satisfaction associated with insulin pump therapy for the pregnancy complicated by type 1 diabetes mellitus.
Am J Obstet Gynecol. 2000 Jun; 182(6):1283-91.AJ

Abstract

OBJECTIVE

Glycemic control, perinatal outcome, and health care costs were evaluated among women with type 1 diabetes mellitus who began insulin pump therapy during pregnancy (group 1, n = 24), were treated with multiple insulin injections (group 2, n = 24), or were already using an insulin pump before pregnancy (group 3, n = 12). Patient satisfaction and continuation of pump therapy post partum were assessed.

STUDY DESIGN

A retrospective review of maternal and neonatal medical records was performed, and a questionnaire was sent to patients after delivery. Patients in groups 1 and 2 were matched for age, age at onset and duration of diabetes mellitus, White class, and date of delivery.

RESULTS

No differences in glycosylated hemoglobin A levels were observed among groups 1, 2 or 3 in the first, second, or third trimester. Patients in group 1 started pump therapy at a mean of 16.8 weeks' gestation, and 17 (70.8%) began therapy as outpatients. No deterioration in glycemic control was noted during the 2- to 4-week period after the start of pump treatment. Among the women in group 1 eight had at least one episode of severe hypoglycemia before starting pump therapy, but only one had such an episode after this treatment was begun. Two episodes of ketoacidosis occurred in group 1, and no episodes occurred in groups 2 and 3. No significant differences in perinatal outcomes or health care costs were observed among groups 1, 2, and 3. After delivery 94. 7% of the women in group 1 continued to use the pump because it provided better glycemic control and a more flexible lifestyle. Postpartum glycosylated hemoglobin A values were 7.2% in group 1 and 9.1% in group 2, a significant difference.

CONCLUSIONS

Insulin pump therapy was initiated during pregnancy without a deterioration of glycemic control and was associated with maternal and perinatal outcomes and health care costs comparable to those among women who were already using the pump before pregnancy or who received multiple-dose insulin therapy. Women who began pump therapy in pregnancy were highly likely to continue pump use after delivery and preferred the flexible lifestyle that this treatment allowed.

Authors+Show Affiliations

Diabetes in Pregnancy Program, Departments of Obstetrics and Gynecology, University of Washington Medical Center, Seattle 98195-6460, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10871440

Citation

Gabbe, S G., et al. "Benefits, Risks, Costs, and Patient Satisfaction Associated With Insulin Pump Therapy for the Pregnancy Complicated By Type 1 Diabetes Mellitus." American Journal of Obstetrics and Gynecology, vol. 182, no. 6, 2000, pp. 1283-91.
Gabbe SG, Holing E, Temple P, et al. Benefits, risks, costs, and patient satisfaction associated with insulin pump therapy for the pregnancy complicated by type 1 diabetes mellitus. Am J Obstet Gynecol. 2000;182(6):1283-91.
Gabbe, S. G., Holing, E., Temple, P., & Brown, Z. A. (2000). Benefits, risks, costs, and patient satisfaction associated with insulin pump therapy for the pregnancy complicated by type 1 diabetes mellitus. American Journal of Obstetrics and Gynecology, 182(6), 1283-91.
Gabbe SG, et al. Benefits, Risks, Costs, and Patient Satisfaction Associated With Insulin Pump Therapy for the Pregnancy Complicated By Type 1 Diabetes Mellitus. Am J Obstet Gynecol. 2000;182(6):1283-91. PubMed PMID: 10871440.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Benefits, risks, costs, and patient satisfaction associated with insulin pump therapy for the pregnancy complicated by type 1 diabetes mellitus. AU - Gabbe,S G, AU - Holing,E, AU - Temple,P, AU - Brown,Z A, PY - 2000/6/28/pubmed PY - 2000/8/1/medline PY - 2000/6/28/entrez SP - 1283 EP - 91 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 182 IS - 6 N2 - OBJECTIVE: Glycemic control, perinatal outcome, and health care costs were evaluated among women with type 1 diabetes mellitus who began insulin pump therapy during pregnancy (group 1, n = 24), were treated with multiple insulin injections (group 2, n = 24), or were already using an insulin pump before pregnancy (group 3, n = 12). Patient satisfaction and continuation of pump therapy post partum were assessed. STUDY DESIGN: A retrospective review of maternal and neonatal medical records was performed, and a questionnaire was sent to patients after delivery. Patients in groups 1 and 2 were matched for age, age at onset and duration of diabetes mellitus, White class, and date of delivery. RESULTS: No differences in glycosylated hemoglobin A levels were observed among groups 1, 2 or 3 in the first, second, or third trimester. Patients in group 1 started pump therapy at a mean of 16.8 weeks' gestation, and 17 (70.8%) began therapy as outpatients. No deterioration in glycemic control was noted during the 2- to 4-week period after the start of pump treatment. Among the women in group 1 eight had at least one episode of severe hypoglycemia before starting pump therapy, but only one had such an episode after this treatment was begun. Two episodes of ketoacidosis occurred in group 1, and no episodes occurred in groups 2 and 3. No significant differences in perinatal outcomes or health care costs were observed among groups 1, 2, and 3. After delivery 94. 7% of the women in group 1 continued to use the pump because it provided better glycemic control and a more flexible lifestyle. Postpartum glycosylated hemoglobin A values were 7.2% in group 1 and 9.1% in group 2, a significant difference. CONCLUSIONS: Insulin pump therapy was initiated during pregnancy without a deterioration of glycemic control and was associated with maternal and perinatal outcomes and health care costs comparable to those among women who were already using the pump before pregnancy or who received multiple-dose insulin therapy. Women who began pump therapy in pregnancy were highly likely to continue pump use after delivery and preferred the flexible lifestyle that this treatment allowed. SN - 0002-9378 UR - https://www.unboundmedicine.com/medline/citation/10871440/Benefits_risks_costs_and_patient_satisfaction_associated_with_insulin_pump_therapy_for_the_pregnancy_complicated_by_type_1_diabetes_mellitus_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(00)16151-4 DB - PRIME DP - Unbound Medicine ER -