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

Overview

Journal Diabetologia

Specialty Endocrinology

Date 2014 Jan 18

PMID 24434960

Citations 27

Authors

Melissa M Kallas-Koeman

Jason M Kong

Jennifer A Klinke

Sonia Butalia

Abhay K Lodha

Ken I Lim

Qiuli M Duan

Lois E Donovan

Affiliations

Soon will be listed here.

Abstract

Aims/hypothesis: The aim of this study was to compare glycaemic control and maternal-fetal outcomes in women with type 1 diabetes managed on insulin pumps compared with multiple daily injections of insulin (MDI).

Methods: In a retrospective study, glycaemic control and outcomes of 387 consecutive pregnancies in women with type 1 diabetes who attended specialised clinics at three centres 2006-2010 were assessed.

Results: Women using insulin pumps (129/387) were older and had a longer duration of diabetes, more retinopathy, smoked less in pregnancy, and had more preconception care (p < 0.01 for each). Among 113 pregnancies >20 weeks' gestation in women on insulin pumps and 218 in women on MDI, there was a significant difference in HbA1c in the first trimester (mean HbA1c 6.90 ± 0.71% (52 ± 7.8 mmol/mol) vs 7.60 ± 1.38% (60 ± 15.1 mmol/mol), p < 0.001), which persisted until the third trimester (mean HbA1c 6.49 ± 0.52% (47 ± 5.7 mmol/mol) vs 6.81 ± 0.85% (51 ± 9.3 mmol/mol), p = 0.002). Rates of diabetic ketoacidosis were similar in women on insulin pumps vs MDI (1.8% vs 3.0%, p = 0.72). Despite lower HbA1c, women on insulin pumps did not have an increased incidence of severe hypoglycaemia (8.0% vs 7.6%, p = 0.90) or more weight gain (16.3 ± 8.7 vs 15.2 ± 6.2 kg, p = 0.18). More large-for-gestational-age infants in the pump group (55.0% vs 39.2%, p = 0.007) may have resulted from confounding by parity.

Conclusions/interpretation: In this large multicentre study, women using insulin pumps in pregnancy had lower HbA1c without increased risk of severe hypoglycaemia or diabetic ketoacidosis but no improvement in other pregnancy outcomes. This information can help inform care providers and patients about the glycaemic effectiveness and safety of insulin pumps in pregnancy.

Citing Articles

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Continuous subcutaneous insulin infusion versus multiple daily injection therapy in pregnant women with type 1 diabetes.

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Advantages of sensor-augmented insulin pump therapy for pregnant women with type 1 diabetes mellitus.

Imafuku H, Tanimura K, Masuko N, Tomimoto M, Shi Y, Uchida A J Diabetes Investig. 2023; 14(12):1383-1390.

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