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

• Published in: Diabetologia Vol. 57; no. 4; pp. 681 - 689
• Main Authors: Kallas-Koeman, Melissa M., Kong, Jason M., Klinke, Jennifer A., Butalia, Sonia, Lodha, Abhay K., Lim, Ken I., Duan, Qiuli M., Donovan, Lois E.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2014; Springer
• Subjects: Adult; Biological and medical sciences; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - metabolism; Diabetes. Impaired glucose tolerance; Diabetic Ketoacidosis - epidemiology; Diabetic Ketoacidosis - metabolism; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glycated Hemoglobin A - metabolism; Human Physiology; Humans; Hypoglycemia - epidemiology; Hypoglycemia - metabolism; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - therapeutic use; Insulin - administration & dosage; Insulin - therapeutic use; Insulin Infusion Systems - adverse effects; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Pregnancy; Retrospective Studies; Young Adult; Pregnancy; Diabetes; Multiple daily injections; Insulin pump; Type 1 diabetes; Continuous subcutaneous insulin infusion; Endocrinopathy; Human; Immunopathology; Autoimmune disease; Metabolic diseases; Acid base balance disorder; Hypoglycemia; Metabolic disorder; Ketoacidosis; Female
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-014-3163-6

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 HbA 1c in the first trimester (mean HbA 1c 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 HbA 1c 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 HbA 1c , 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 HbA 1c 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.