The incidence of severe hypoglycaemia in pregnant women with type 1 diabetes mellitus can be reduced with unchanged HbA1c levels and pregnancy outcomes in a routine care setting

详细信息    查看全文

• 作者：Lene Ringholm ; A.L. Secher ; U. Pedersen-Bjergaard ; B. Thorsteinsson ; H.U. Andersen ; P. Damm ; E.R. Mathiesen
• 关键词：CGM ; continuous glucose monitoring ; SMPG ; self-monitored plasma glucose
• 刊名：Diabetes Research and Clinical Practice
• 出版年：2013
• 出版时间：August, 2013
• 年：2013
• 卷：101
• 期：2
• 页码：123-130
• 全文大小：687 K

文摘

Aims

To investigate whether the incidence of severe hypoglycaemia in pregnant women with type 1 diabetes can be reduced without deteriorating HbA1c levels or pregnancy outcomes in a routine care setting.

Methods

Two cohorts (2004-2006; n = 108 and 2009-2011; n = 104) were compared. In between the cohorts a focused intervention including education of caregivers and patients in preventing hypoglycaemia was implemented. Women were included at median 8 (range 5-13) weeks. Severe hypoglycaemia (requiring assistance from others) was prospectively reported in structured interviews.

Results

In the first vs. second cohort, severe hypoglycaemia during pregnancy occurred in 45 % vs. 23 % , p = 0.0006, corresponding to incidences of 2.5 vs. 1.6 events/patient-year, p = 0.04. Unconsciousness and/or convulsions occurred at 24 % vs. 8 % of events. Glucagon and/or glucose injections were given at 15 % vs. 5 % of events. At inclusion HbA1c was comparable between the cohorts while in the second cohort fewer women reported impaired hypoglycaemia awareness (56 % vs. 36 % , p = 0.0006), insulin dose in women on multiple daily injections was lower (0.77 IU/kg (0.4-1.7) vs. 0.65 (0.2-1.4), p = 0.0006) and more women were on insulin analogues (rapid-acting 44 % vs. 97 % , p < 0.0001; long-acting 6 % vs. 76 % , p < 0.0001) and insulin pumps (5 % vs. 23 % , p < 0.0001). Pregnancy outcomes were similar in the two cohorts.

Conclusions

A 36 % reduction in the incidence of severe hypoglycaemia in pregnancy with unchanged HbA1c levels and pregnancy outcomes was observed after implementation of focused intervention against severe hypoglycaemia in a routine care setting. Improved insulin treatment, increased health professional education and fewer women with impaired hypoglycaemia awareness may contribute.