Pregnancy outcome and glycemic control in women with type 1 diabetes: A retrospective comparison between CSII and MDI treatment

Dia Care - Diabetes Care and Hormone Clinic, Ahmedabad, India.
Diabetes & metabolic syndrome 04/2013; 7(2):68-71. DOI: 10.1016/j.dsx.2013.02.032
Source: PubMed


Present study was aimed to evaluate glycemic control and maternal-fetal outcome in pregnant type 1 diabetic patient treated with continuous subcutaneous insulin infusion (CSII) or multiple daily injections of insulin (MDI).
A retrospective observational study included thirty-four pregnant type 1 diabetic patients. Patients were divided into two group, CSII treated group (n=14) and MDI treated group (n=20). The HbA1c level and maternal-fetal outcome were evaluated in both the treatment group. Outcome parameters such as glycemic control (HbA1c), hypoglycemic events, time and mode of delivery and labor results (abortion, premature labor, perinatal mortality, neonatal weight, Apgar score, neonatal hypoglycaemia, presence of congenital abnormalities) were analyzed.
Pregnancy outcome and glycemic control in pregnant type 1 diabetic patients treated with CSII and MDI were evaluated and compared. Two groups were compared for their epidemiological parameters, although patients on CSII treatment had longer duration of diabetes compared to MDI treated group. Reduction in HbA1c level was higher in CSII treated patients at first (CSII: 0.9% vs MDI: 0.46%), second (CSII: 1.58% vs MDI: 0.78%) and third trimester (CSII: 1.74% vs MDI: 1.09%) of pregnancy compared to MDI treated patients. Duration of pregnancy and new born baby weight were founded similar in both group. Moreover, the rate of abortion, preterm labor, cesarean section and hypoglycemia in new born were founded less in CSII treated group compared to MDI treated group and Apgar score was significantly (p<0.05) higher in CSII treated group compared to MDI treated group.
Results of present study revealed that the CSII gives better glycemic control and pregnancy outcome in pregnant type 1 diabetic patients compared to MDI treatment. CSII also decreases the daily insulin requirement compared MDI.

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    ABSTRACT: Optimal metabolic control is the goal in pregnancies complicated by diabetes. Studies of the glucose metabolism in physiological pregnancy indicate that the concept of "normality" in pregnancy is definitely different from what is "normal" outside pregnancy. Knowledge of the pathophysiology of the carbohydrate metabolism in pregnancy and changes in the glycemic profile and the patients' characteristics should guide the choice of insulin therapy and mode of delivery. Prospective trials with the insulin analogs aspart and detemir showed that in the preconceptional period these reduced the risk of nocturnal hypoglycemia and improved glycemic profiles. Although insulin analogs did not appear to show any particular superiority over human insulin the women enrolled from preconception had better outcomes. Meta-analysis on insulin lispro and on glargine showed no worsening of fetal malformations compared with human insulin. Even today, unfortunately, the objectives of the Saint Vincent's Declaration for pregnancy have not been fully achieved. Insulin analogs should be favored as early as possible in preconception counseling to stabilize metabolic control better and obtain more favorable maternal and fetal outcomes. Despite the paucity of clinical trials in pregnancy, some experts still consider the insulin pump (CSII) the first choice in the treatment of type 1 diabetes and it can be an effective tool in highly selected pregnant women. Women using an insulin pump during pregnancy maintain better glycemic control in the postpartum period too. In addition their metabolic control improves faster, they have a lower insulin requirement and fewer episodes of hypoglycemia, with better metabolic control at term. This therapy must take account of the overall burden, indications to treatment and selection of patients by an experienced team. Continuous glucose monitoring (CGM) can be useful in carefully selected pregnant women. Integrated CSII-CGM systems are attracting increasing attention, above all from the perspective of "closing the loop".
    No preview · Article · Dec 2013 · Giornale Italiano di Diabetologia e Metabolismo
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    ABSTRACT: The use of insulin pump in diabetes is likely to increase with recent advances in technology. Although the evidence for the superiority of pumps over multiple daily injections (MDI) is inconsistent, data from accumulating uncontrolled studies indicate greater reductions in glycated haemoglobin in patients switching to continuous subcutaneous insulin infusion (CSII) from MDI therapy. Due to the variability in insulin requirements and sensitivity to CSII pumps, hyperglycaemia in these patients is managed by endocrinologists using individualised therapy. A panel of experts reviewed the existing guidelines and framed recommendations specific to the clinical practice in Indian conditions for use of CSII pumps in the management of hyperglycaemia. Selection of right patient with basic education, motivation and learning skills are essential for successful implementation of CSII therapy with sophisticated programmes. Rapid acting insulin analogues with better pharmacokinetic and pharmacodynamic profile, physical and chemical stability and compatibility with most commercially available insulin pumps are preferred over regular insulin to achieve safe and stable glycaemic control. Further, educating pump users on proper use of CSII pumps, insulin dose adjustments, and handling of accessories are recommended in the current consensus guidelines. Practice of self-monitoring of blood glucose and glycated haemoglobin levels are essential to adjust insulin dosage for the management of diabetes. Use of CSII pumps in special patient populations should be carefully assessed and initiated by endocrinologist. The proposed guidelines can form a basis for use of CSII pumps in the management of hyperglycaemia in the Indian scenario.
    No preview · Article · Jul 2014 · The Journal of the Association of Physicians of India
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    ABSTRACT: We systematically reviewed the effectiveness and safety of continuous subcutaneous insulin infusion (CSII) with insulin analogs compared with multiple daily injections (MDI) in pregnant women with diabetes mellitus. We searched Medline®, Embase®, and the Cochrane Central Register of Controlled Trials through May 2013. Studies comparing CSII with MDI in pregnant women with diabetes mellitus were included. Studies using regular insulin CSII were excluded. We conducted meta-analyses where there were two or more comparable studies based on the type of insulin used in the MDI arm. Seven cohort studies of pregnant women with type 1 diabetes reported improvement in hemoglobin A1c (HbA1c) in both groups. Meta-analysis showed no difference in maternal and fetal outcomes for CSII versus MDI. Results were similar when CSII was compared with MDI with insulin analogs or regular insulin. Studies had moderate to high risk bias with incomplete descriptions of study methodology, populations, treatments, follow up, and outcomes. We conclude that observational studies reported similar improvements in HbA1c with CSII and MDI during pregnancy, but evidence was insufficient to rule out possible important differences between CSII and MDI for maternal and fetal outcomes. This highlights the need for future studies to examine the effectiveness and safety of CSII with insulin analogs and MDI in pregnant women with diabetes mellitus.
    Full-text · Article · Feb 2015 · Journal of Women's Health
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