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

• Published in: Diabetes research and clinical practice Vol. 101; no. 2; pp. 123 - 130
• Main Authors: Ringholm, Lene, Secher, A.L, Pedersen-Bjergaard, U, Thorsteinsson, B, Andersen, H.U, Damm, P, Mathiesen, E.R
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.08.2013
• Subjects: Blood Glucose - metabolism; Blood Glucose Self-Monitoring; Cohort Studies; Continuous glucose monitoring; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; Education; Endocrinology & Metabolism; Female; Glucagon - therapeutic use; Glucose - therapeutic use; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemia - blood; Hypoglycemia - drug therapy; Insulin - therapeutic use; Insulin analogue; Insulin dose; Insulin pump therapy; Pregnancy; Pregnancy Outcome; Severe hypoglycaemia; Type 1 diabetes mellitus; Pregnancy; self-monitored plasma glucose; Insulin pump therapy; Education; Insulin dose; SMPG; CGM; continuous glucose monitoring; Severe hypoglycaemia; Insulin analogue; Type 1 diabetes mellitus; Continuous glucose monitoring
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2013.06.002

Abstract 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.