Tags

Type your tag names separated by a space and hit enter

Evaluation of Glycaemic Control, Glucose Variability and Hypoglycaemia on Long-Term Continuous Subcutaneous Infusion vs. Multiple Daily Injections: Observational Study in Pregnancies With Pre-Existing Type 1 Diabetes.
Diabetes Ther. 2020 Feb 15 [Online ahead of print]DT

Abstract

INTRODUCTION

We evaluated the effectiveness of long-term continuous subcutaneous insulin infusion (CSII) compared with multiple daily insulin (MDI) injections for glycaemic control and variability, hypoglycaemic episodes and maternal/neonatal outcomes in pregnant women with pre-existing type 1 diabetes (pT1D).

METHODS

Our observational cohort study included 128 consecutive pregnant women with pT1D, who were treated from 1 January 2010 to 31 December 2017. Of 128 participants, 48 were on CSII and 80 were on MDI. Glycaemic control was determined by glycated haemoglobin (HbA1c) (captured in preconception and each trimester of pregnancy). Glucose variability (GV) was expressed as the coefficient of variation (CV) [calculated from self-monitoring of blood glucose (SMBG) values], and hypoglycaemia was defined as glucose values < 3.9 mmol/l. The data on maternal and neonatal outcomes were collected from obstetrical records.

RESULTS

Duration of the treatment was 8.8 ± 5.3 years in the CSII and 12.6 ± 8.0 years in the MDI group. The CSII lowered HbA1c in preconception (7.1 ± 0.1 vs. 7.9 ± 0.2%, p = 0.03) and the first (6.9 ± 0.1 vs. 7.7 ± 0.2%, p = 0.02), second (6.6 ± 0.1 vs. 7.2 ± 0.1%, p = 0.003) and third (6.5 ± 0.1 vs. 6.8 ± 0.1%, p = 0.02) trimesters significantly better than MDI. Significantly lower CV was observed only for fasting glycaemia in the first trimester (17.1 vs 28.4%, p < 0.001) in favour of CSII. Moreover, the CSII group had significantly lower mean hypoglycaemic episodes/week/patient only during the first trimester (2.0 ± 1.7 vs 4.8 ± 1.5, p < 0.01). In early pregnancy, the majority of women on CSII had less hypoglycaemia than on MDI (0-3: 79.1 vs. 29.1%; 4-6: 18.8 vs. 65.8%; ≥ 7: 2.1 vs. 5.1%, p < 0.01, respectively). We found no difference in the incidence of adverse maternal/neonatal outcomes.

CONCLUSIONS

Treatment with CSII resulted in a favourable reduction of HbA1c in the preconception period and each trimester in pregnancy. Moreover, long-term CSII treatment demonstrated more stable metabolic control with less GV of fasting glycaemia and fewer hypoglyacemic episodes only during early pregnancy.

Authors+Show Affiliations

Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia. aleksandra.z.jotic@gmail.com. Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia. aleksandra.z.jotic@gmail.com.Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia. Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia.Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia. Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia.Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia. Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia.Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia. Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia.Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia.Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia.Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia. Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia.Department for Operations Research and Statistics, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia.Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia. Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32060738

Citation

Jotic, Aleksandra, et al. "Evaluation of Glycaemic Control, Glucose Variability and Hypoglycaemia On Long-Term Continuous Subcutaneous Infusion Vs. Multiple Daily Injections: Observational Study in Pregnancies With Pre-Existing Type 1 Diabetes." Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders, 2020.
Jotic A, Milicic T, Lalic K, et al. Evaluation of Glycaemic Control, Glucose Variability and Hypoglycaemia on Long-Term Continuous Subcutaneous Infusion vs. Multiple Daily Injections: Observational Study in Pregnancies With Pre-Existing Type 1 Diabetes. Diabetes Ther. 2020.
Jotic, A., Milicic, T., Lalic, K., Lukic, L., Macesic, M., Stanarcic Gajovic, J., Stoiljkovic, M., Gojnic Dugalic, M., Jeremic, V., & Lalic, N. M. (2020). Evaluation of Glycaemic Control, Glucose Variability and Hypoglycaemia on Long-Term Continuous Subcutaneous Infusion vs. Multiple Daily Injections: Observational Study in Pregnancies With Pre-Existing Type 1 Diabetes. Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders. https://doi.org/10.1007/s13300-020-00780-7
Jotic A, et al. Evaluation of Glycaemic Control, Glucose Variability and Hypoglycaemia On Long-Term Continuous Subcutaneous Infusion Vs. Multiple Daily Injections: Observational Study in Pregnancies With Pre-Existing Type 1 Diabetes. Diabetes Ther. 2020 Feb 15; PubMed PMID: 32060738.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of Glycaemic Control, Glucose Variability and Hypoglycaemia on Long-Term Continuous Subcutaneous Infusion vs. Multiple Daily Injections: Observational Study in Pregnancies With Pre-Existing Type 1 Diabetes. AU - Jotic,Aleksandra, AU - Milicic,Tanja, AU - Lalic,Katarina, AU - Lukic,Ljiljana, AU - Macesic,Marija, AU - Stanarcic Gajovic,Jelena, AU - Stoiljkovic,Milica, AU - Gojnic Dugalic,Miroslava, AU - Jeremic,Veljko, AU - Lalic,Nebojsa M, Y1 - 2020/02/15/ PY - 2019/12/29/received PY - 2020/2/16/entrez PY - 2020/2/16/pubmed PY - 2020/2/16/medline KW - Continuous subcutaneous insulin infusion KW - Glucose variability KW - Pregnancy KW - Type 1 diabetes JF - Diabetes therapy : research, treatment and education of diabetes and related disorders JO - Diabetes Ther N2 - INTRODUCTION: We evaluated the effectiveness of long-term continuous subcutaneous insulin infusion (CSII) compared with multiple daily insulin (MDI) injections for glycaemic control and variability, hypoglycaemic episodes and maternal/neonatal outcomes in pregnant women with pre-existing type 1 diabetes (pT1D). METHODS: Our observational cohort study included 128 consecutive pregnant women with pT1D, who were treated from 1 January 2010 to 31 December 2017. Of 128 participants, 48 were on CSII and 80 were on MDI. Glycaemic control was determined by glycated haemoglobin (HbA1c) (captured in preconception and each trimester of pregnancy). Glucose variability (GV) was expressed as the coefficient of variation (CV) [calculated from self-monitoring of blood glucose (SMBG) values], and hypoglycaemia was defined as glucose values < 3.9 mmol/l. The data on maternal and neonatal outcomes were collected from obstetrical records. RESULTS: Duration of the treatment was 8.8 ± 5.3 years in the CSII and 12.6 ± 8.0 years in the MDI group. The CSII lowered HbA1c in preconception (7.1 ± 0.1 vs. 7.9 ± 0.2%, p = 0.03) and the first (6.9 ± 0.1 vs. 7.7 ± 0.2%, p = 0.02), second (6.6 ± 0.1 vs. 7.2 ± 0.1%, p = 0.003) and third (6.5 ± 0.1 vs. 6.8 ± 0.1%, p = 0.02) trimesters significantly better than MDI. Significantly lower CV was observed only for fasting glycaemia in the first trimester (17.1 vs 28.4%, p < 0.001) in favour of CSII. Moreover, the CSII group had significantly lower mean hypoglycaemic episodes/week/patient only during the first trimester (2.0 ± 1.7 vs 4.8 ± 1.5, p < 0.01). In early pregnancy, the majority of women on CSII had less hypoglycaemia than on MDI (0-3: 79.1 vs. 29.1%; 4-6: 18.8 vs. 65.8%; ≥ 7: 2.1 vs. 5.1%, p < 0.01, respectively). We found no difference in the incidence of adverse maternal/neonatal outcomes. CONCLUSIONS: Treatment with CSII resulted in a favourable reduction of HbA1c in the preconception period and each trimester in pregnancy. Moreover, long-term CSII treatment demonstrated more stable metabolic control with less GV of fasting glycaemia and fewer hypoglyacemic episodes only during early pregnancy. SN - 1869-6953 UR - https://www.unboundmedicine.com/medline/citation/32060738/Evaluation_of_Glycaemic_Control,_Glucose_Variability_and_Hypoglycaemia_on_Long-Term_Continuous_Subcutaneous_Infusion_vs._Multiple_Daily_Injections:_Observational_Study_in_Pregnancies_With_Pre-Existing_Type_1_Diabetes L2 - https://dx.doi.org/10.1007/s13300-020-00780-7 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.