Langer O, Anyaegbunam A, Brustman L, Guidetti D, Levy J, Mazze R
Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY 10461.
Am J Obstet Gynecol. 1988 Sep;159(3):616-21. doi: 10.1016/s0002-9378(88)80020-6.
The management of pregestational diabetes requires tight metabolic control to reduce maternal and perinatal morbidity and mortality. It has been suggested that type I diabetes is a disorder characterized by insulin deficiency and type II diabetes is characterized by insulin resistance; however, it may be hypothesized that a difference in insulin requirements should emerge throughout pregnancy to reflect the dissimilarities in these two metabolic disturbances. The current investigation of 103 women with pregestational diabetes used a novel approach (reflectance meters with onboard memories) to uncover the actual insulin dosages required to reach and maintain optimum metabolic control throughout pregnancy. It was found that both type I and type II diabetes appear to have a triphasic insulin pattern, with the patient having type II diabetes requiring significantly higher doses of insulin during each trimester. This seems to suggest that the hormonal changes in pregnancy may have a similar effect on both type I and type II diabetes but to a different degree. Thus this should be considered in the treatment of pregestational diabetes and in the development of an algorithm for diabetes management.
孕前糖尿病的管理需要严格的代谢控制，以降低孕产妇和围产期的发病率及死亡率。有人提出，I型糖尿病是以胰岛素缺乏为特征的疾病，II型糖尿病是以胰岛素抵抗为特征的疾病；然而，可以推测，在整个孕期胰岛素需求应该会出现差异，以反映这两种代谢紊乱的不同之处。目前对103名孕前糖尿病女性的调查采用了一种新方法（带有机载存储器的反射仪），以揭示在整个孕期达到并维持最佳代谢控制所需的实际胰岛素剂量。结果发现，I型和II型糖尿病似乎都有一个三相胰岛素模式，患有II型糖尿病的患者在每个孕期都需要显著更高剂量的胰岛素。这似乎表明，孕期的激素变化对I型和II型糖尿病可能有类似的影响，但程度不同。因此，在孕前糖尿病的治疗以及糖尿病管理算法的制定中应考虑到这一点。
