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

IF 3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM Journal of Diabetes Pub Date : 2024-04-25 DOI:10.1111/1753-0407.13558

Yixin Gong, Tian Wei, Yujie Liu, Jing Wang, Jinhua Yan, Daizhi Yang, Sihui Luo, Jianping Weng, Xueying Zheng

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Abstract

Introduction

The study aimed to compare glycemic control and pregnancy outcomes in women with type 1 diabetes mellitus (T1DM) using multiple daily injection therapy (MDI) and continuous subcutaneous insulin infusion (CSII) and to compare outcomes of women treated with long-acting insulin or neutral protamine Hagedorn (NPH).

Methods

This multicenter prospective cohort study involved women with pregestational T1DM treated with MDI and CSII. Primary outcome was glycated hemoglobin (HbA1c) before and during pregnancy. Secondary outcomes included maternal and neonatal outcomes and quality of life.

Results

Of the 121 studied women, the average age was 28.48 years, and the average body mass index was 21.29 kg/m² at conception and 26.32 kg/m² at delivery. Of the studied women, 78.51% had planned pregnancy. Women treated with MDI and CSII had comparable HbA1c before pregnancy or in the first and second trimesters. In the third trimester, women on CSII therapy had significantly lower HbA1c (6.07 ± 0.62 vs 6.20 ± 0.88%, p = .017), higher HbA1c on-target rate (71.43% vs 64.62%, p = .030), and greater decline of HbA1c from preconception to the third trimester (−0.65 vs −0.30%, p = .047). Fewer daily insulin requirements were observed in those used CSII compared with MDI-treated women (0.60 ± 0.22 vs 0.73 ± 0.25 U/kg/day, p = .004). Newborns born of mothers treated with the CSII method were more likely to have neonatal jaundice (adjusted odds ratio [OR] 2.76, 95% confidence interval [CI] 1.16–6.57) and neonatal intensive care unit (adjusted OR 3.73, 95%CI 1.24–11.16), and women on CSII had lower scores in patient-reported quality of life (p = .045). In the MDI group, those receiving long-acting insulin had nonsignificant lower HbA1c and higher HbA1c on-target rate in the second and third trimesters, compared with those treated with NPH.

Conclusions

Insulin pump users may achieve better glycemic control than multiple daily insulin injections, which did not substantially improve pregnancy outcome.

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1 型糖尿病孕妇皮下持续输注胰岛素与每日多次注射疗法的比较

引言该研究旨在比较采用每日多次注射疗法（MDI）和持续皮下注射胰岛素疗法（CSII）的 1 型糖尿病（T1DM）女性患者的血糖控制和妊娠结局，并比较采用长效胰岛素或中性原研胰岛素（NPH）治疗的女性患者的妊娠结局。方法这项多中心前瞻性队列研究涉及接受 MDI 和 CSII 治疗的妊娠前 T1DM 女性患者。主要结果是孕前和孕期糖化血红蛋白（HbA1c）。次要结果包括产妇和新生儿的预后以及生活质量。结果在研究的 121 名妇女中，平均年龄为 28.48 岁，受孕时的平均体重指数为 21.29 kg/m2，分娩时的平均体重指数为 26.32 kg/m2。在研究的妇女中，78.51%是计划怀孕。接受 MDI 和 CSII 治疗的妇女在孕前或孕期前三个月和后三个月的 HbA1c 值相当。在第三个孕期，接受 CSII 治疗的女性 HbA1c 明显降低（6.07 ± 0.62 vs 6.20 ± 0.88%，p = .017），HbA1c 达标率更高（71.43% vs 64.62%，p = .030），从怀孕前到第三个孕期的 HbA1c 下降幅度更大（-0.65 vs -0.30%，p = .047）。与使用 MDI 的妇女相比，使用 CSII 的妇女每日胰岛素需求量更少（0.60 ± 0.22 vs 0.73 ± 0.25 U/kg/天，p = .004）。使用 CSII 方法的母亲所生的新生儿更有可能出现新生儿黄疸（调整后的几率比 [OR] 2.76，95% 置信区间 [CI] 1.16-6.57）和新生儿重症监护室（调整后的几率比 3.73，95% 置信区间 [CI] 1.24-11.16），使用 CSII 的妇女在患者报告的生活质量方面得分较低（p = 0.045）。在 MDI 组中，与接受 NPH 治疗的产妇相比，接受长效胰岛素治疗的产妇在第二和第三孕期的 HbA1c 和 HbA1c 达标率均无显著降低。结论胰岛素泵使用者可能比每日多次注射胰岛素者获得更好的血糖控制，但每日多次注射胰岛素并不能显著改善妊娠结局。

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来源期刊

Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

2.20%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Diabetes (JDB) devotes itself to diabetes research, therapeutics, and education. It aims to involve researchers and practitioners in a dialogue between East and West via all aspects of epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes, including the molecular, biochemical, and physiological aspects of diabetes. The Editorial team is international with a unique mix of Asian and Western participation. The Editors welcome submissions in form of original research articles, images, novel case reports and correspondence, and will solicit reviews, point-counterpoint, commentaries, editorials, news highlights, and educational content.