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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 05; 19(5):280-287.DT

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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    • Authors+Show Affiliations

    Abell SK
    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 .
    Suen M
    2 Diabetes and Vascular Medicine Unit , Monash Health, Clayton, Australia .
    Pease A
    2 Diabetes and Vascular Medicine Unit , Monash Health, Clayton, Australia .
    Boyle JA
    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 .
    Soldatos G
    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 .
    Regan J
    3 Monash Women's Services , Monash Health, Department of Obstetrics and Gynecology, Clayton, Australia .
    Wallace EM
    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 .
    Teede HJ
    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 .

    MeSH

    AdultCohort StudiesDiabetes Mellitus, Type 1Drug Administration ScheduleFemaleGlycated Hemoglobin AHospitals, UniversityHumansHyperglycemiaHypoglycemiaHypoglycemic AgentsInfusions, SubcutaneousInjections, SubcutaneousInsulinInsulin Infusion SystemsPatient Care TeamPregnancyPregnancy OutcomePregnancy in DiabeticsReproducibility of ResultsRetrospective StudiesVictoria

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    28282241

    Citation

    Abell, Sally K., et al. "Pregnancy Outcomes and Insulin Requirements in Women With Type 1 Diabetes Treated With Continuous Subcutaneous Insulin Infusion and Multiple Daily Injections: Cohort Study." Diabetes Technology & Therapeutics, vol. 19, no. 5, 2017, pp. 280-287.
    Abell SK, Suen M, Pease A, et al. 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(5):280-287.
    Abell, S. K., Suen, M., Pease, A., Boyle, J. A., Soldatos, G., Regan, J., Wallace, E. M., & Teede, H. J. (2017). Pregnancy Outcomes and Insulin Requirements in Women with Type 1 Diabetes Treated with Continuous Subcutaneous Insulin Infusion and Multiple Daily Injections: Cohort Study. Diabetes Technology & Therapeutics, 19(5), 280-287. https://doi.org/10.1089/dia.2016.0412
    Abell SK, et al. 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(5):280-287. PubMed PMID: 28282241.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Pregnancy Outcomes and Insulin Requirements in Women with Type 1 Diabetes Treated with Continuous Subcutaneous Insulin Infusion and Multiple Daily Injections: Cohort Study. AU - Abell,Sally K, AU - Suen,Matthew, AU - Pease,Anthony, AU - Boyle,Jacqueline A, AU - Soldatos,Georgia, AU - Regan,John, AU - Wallace,Euan M, AU - Teede,Helena J, Y1 - 2017/03/10/ PY - 2017/3/11/pubmed PY - 2018/3/13/medline PY - 2017/3/11/entrez KW - Continuous subcutaneous insulin infusion KW - HbA1c pregnancy KW - Insulin pump KW - Pregnancy outcome KW - Type 1 diabetes SP - 280 EP - 287 JF - Diabetes technology & therapeutics JO - Diabetes Technol. Ther. VL - 19 IS - 5 N2 - 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. SN - 1557-8593 UR - https://www.unboundmedicine.com/medline/citation/28282241/Pregnancy_Outcomes_and_Insulin_Requirements_in_Women_with_Type_1_Diabetes_Treated_with_Continuous_Subcutaneous_Insulin_Infusion_and_Multiple_Daily_Injections:_Cohort_Study_ L2 - https://www.liebertpub.com/doi/full/10.1089/dia.2016.0412?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
    Grapherence [↓3]

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