Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Endocrinology, Skåne University Hospital, Malmö, Sweden.
Acta Obstet Gynecol Scand. 2021 May;100(5):927-933. doi: 10.1111/aogs.14039. Epub 2021 Jan 12.
Continuous glucose monitoring (CGM) provides detailed information about glucose level fluctuations over time. The method is increasingly being used in pregnant women with type 1 diabetes. However, only one previous study compared CGM results related to pregnancy outcomes in women using insulin pumps with those administering multiple daily injections (MDI). We performed a secondary analysis of CGM metrics from an observational cohort of pregnant women with type 1 diabetes and compared insulin pump and MDI therapies in relation to maternal and neonatal outcomes.
The study included 185 pregnant Swedish women with type 1 diabetes undergoing CGM throughout pregnancy. Women were divided according to insulin administration mode, ie MDI (n = 131) or pump (n = 54). A total of 91 women used real-time CGM and 94 women used intermittently viewed CGM. Maternal demographics and maternal and neonatal outcome data were collected from medical records. CGM data were analyzed according to predefined glycemic indices: mean glucose; standard deviation; percentage of time within, below and above glucose target range; mean amplitude of glycemic excursion; high and low glucose indices; and coefficient variation in percent. Associations between insulin administration mode and CGM data, on the one hand, and maternal and neonatal outcomes, on the other, were analyzed with analysis of covariance and logistic regression, respectively, adjusted for confounders.
There were no differences in maternal characteristics or glycemic indices between the MDI and pump groups, except for a longer duration of type 1 diabetes and higher frequencies of microangiopathy and real-time CGM among pump users. Despite improvement with each trimester, glucose levels remained suboptimal throughout pregnancy in both groups. There were no differences between the MDI and pump groups concerning the respective associations with any of the outcomes. The frequency of large for gestational age was high in both groups (MDI 49% vs pump 63%) and did not differ significantly.
Pregnant women with type 1 diabetes did not differ in glycemic control or pregnancy outcome, related to MDI or pump administration of insulin. Glycemic control remained suboptimal throughout pregnancy, regardless of insulin administration mode.
连续血糖监测（CGM）可提供有关随时间推移血糖水平波动的详细信息。该方法在 1 型糖尿病孕妇中的应用越来越多。然而，之前只有一项研究比较了使用胰岛素泵和多次皮下注射（MDI）的女性的 CGM 结果与妊娠结局的关系。我们对 1 型糖尿病孕妇的观察队列中的 CGM 指标进行了二次分析，并比较了胰岛素泵和 MDI 治疗与母婴结局的关系。
该研究纳入了 185 名在整个孕期接受 CGM 的瑞典 1 型糖尿病孕妇。根据胰岛素给药方式将女性分为 MDI（n=131）或泵（n=54）组。共有 91 名女性使用实时 CGM，94 名女性使用间断查看 CGM。从病历中收集了女性的人口统计学资料和母婴结局数据。根据预先定义的血糖指标分析 CGM 数据：平均血糖；标准差；血糖目标范围内、以下和以上的时间百分比；血糖波动幅度的平均振幅；高低血糖指数；以及变异系数。使用协方差分析和逻辑回归分别分析胰岛素给药方式与 CGM 数据以及与母婴结局的关系，调整了混杂因素。
MDI 组和泵组之间的女性特征或血糖指标没有差异，除了泵组的 1 型糖尿病病程较长、微血管并发症发生率较高和使用实时 CGM 外。尽管随着每三个月的进展有所改善，但两组孕妇的血糖水平在整个孕期仍不理想。MDI 组和泵组之间与任何结局相关的差异均无统计学意义。两组巨大儿的发生率均较高（MDI 组 49% vs 泵组 63%），差异无统计学意义。
1 型糖尿病孕妇在血糖控制或妊娠结局方面，MDI 或胰岛素泵给药没有差异。无论胰岛素给药方式如何，整个孕期的血糖控制仍不理想。
