Howorka K, Pumprla J, Gabriel M, Feiks A, Schlusche C, Nowotny C, Schober E, Waldhoer T, Langer M
Research Group Functional Rehabilitation and Group Education, Institute of Biomedical Engineering and Physics, University of Vienna, Vienna, Austria.
Diabet Med. 2001 Dec;18(12):965-72. doi: 10.1046/j.1464-5491.2001.00621.x.
To investigate whether modular out-patient group education for flexible, Functional Insulin Treatment (FIT) adapted for pregnancy can eliminate diabetes-associated neonatal complications in pregestational diabetes.
Outcome analysis of the modular out-patient group education and FIT based on separate insulin dosages for fasting, eating or correcting hyperglycaemia in 76 consecutive pregnancies (in 20 cases first after conception) of 59 patients with pregestational diabetes (Type 1 diabetes, n = 54).
(a) diabetic pregnancies: historical controls; (b) non-diabetic pregnancies: retrospective case-controlled study; (c) population-based data of all Austrian newborns registered within the respective time period.
HbA1c of 113 +/- 18% of mean value (= 100%) of non-diabetic, non-pregnant population (103 +/- 14% during the last pregnancy trimester), and self-monitored blood glucose of 5.6 +/- 0.7 mmol/l (5.3 +/- 0.7 mmol/l during the last trimester) was achieved throughout all FIT pregnancies. Severe hypoglycaemia occurred in 14 pregnancies. The gestational age at delivery was 39.2 +/- 1.5 weeks (four cases (5.4%) < 37 weeks) with a birth weight of 3305 +/- 496 g. Four newborns (5.3%) were above the 90th, and nine (11.8%) below the 10th percentile for weight of reference population-based data. Hypoglycaemia was recorded in six newborns (8%). Malformations were found in two infants whose mothers booked for diabetes FIT education only after conception. The caesarean delivery rate was 25%. In comparison with historical diabetic pregnancy controls we demonstrated a reduction in major complications, and compared with non-diabetic women, a lowering of diabetes-related neonatal complication rates to general population levels.
Structured, comprehensive, modular out-patient group education promoting self-choice of insulin dose for flexible, normal eating prior to conception normalizes pregnancy outcome in diabetes.
探讨针对妊娠期灵活的功能性胰岛素治疗（FIT）进行的模块化门诊小组教育能否消除孕前糖尿病患者与糖尿病相关的新生儿并发症。
对59例孕前糖尿病患者（1型糖尿病，n = 54）的76次连续妊娠（其中20例为受孕后首次妊娠）进行基于空腹、进食或纠正高血糖的不同胰岛素剂量的模块化门诊小组教育和FIT的结果分析。
（a）糖尿病妊娠：历史对照；（b）非糖尿病妊娠：回顾性病例对照研究；（c）相应时间段内所有奥地利新生儿的基于人群的数据。
在所有接受FIT治疗的妊娠中，糖化血红蛋白（HbA1c）达到非糖尿病、未怀孕人群平均值（= 100%）的113 ± 18%（妊娠最后三个月为103 ± 14%），自我监测血糖为5.6 ± 0.7 mmol/l（妊娠最后三个月为5.3 ± 0.7 mmol/l）。14例妊娠发生严重低血糖。分娩时的孕周为39.2 ± 1.5周（4例（5.4%）< 37周），出生体重为3305 ± 496 g。4例新生儿（5.3%）体重高于参考人群数据的第90百分位数，9例（11.8%）低于第10百分位数。6例新生儿（8%）记录有低血糖。在2例母亲仅在受孕后才预约糖尿病FIT教育的婴儿中发现畸形。剖宫产率为25%。与历史糖尿病妊娠对照相比，我们证明主要并发症有所减少，与非糖尿病女性相比，糖尿病相关新生儿并发症发生率降至一般人群水平。
在孕前促进灵活、正常饮食的胰岛素剂量自我选择的结构化、全面、模块化门诊小组教育可使糖尿病患者的妊娠结局正常化。
