The best outcomes for going through pregnancy with diabetes-Clinical features of four recipients of the Lilly Insulin 50-Year Award.

The Lilly Insulin 50-Year Award of Japan has been held since 2003. This Award is presented to people with diabetes based on their efforts in injecting insulin for 50 years. Among the 23 recipients of this Award in 2018, four were recognized because of their excellent efforts in receiving continuous treatment for diabetes mellitus before, during and throughout their life after pregnancy. This report focuses on the clinical features of these recipients with successful delivery of newborns at Tokyo Women's Medical University approximately 40-50 years ago. Three of the recipients [type 2 diabetes, = 2 (cases 1 and 3); type 1 diabetes, = 1 (case 4)] were treated before, during and after pregnancy, whereas one patient with type 2 diabetes (case 2) was only treated during pregnancy. Even though three recipients had a past history of stillbirth due to insufficient control of diabetes, all four recipients were directed to try to maintain normoglycemia before and during pregnancy, which resulted in the delivery of newborns without major events. The current ages of the recipients are 82, 78, 78 and 63 years old, respectively. No diabetic complications were observed in case 1. However, simple retinopathy occurred after ophthalmological treatment in case 3, and case 2 has received hemodialysis. Nevertheless, all of the patients have spent active lives with the confidence of successful delivery, even though none of the patient's HbA1c levels fell below 7% after delivery. The authors as their doctors are proud of the continuous efforts made by these four recipients to receive diabetes treatment before, during and after pregnancy. We therefore advocate "the best outcome for going through pregnancy with diabetes" to all diabetic patients who hope to become pregnant based on a planned pregnancy with the normalization of blood glucose.