Department of Clinical and Molecular Medicine Sapienza University of Rome, Rome, Italy.
Azienda Sanitaria Locale Salerno, Salerno, Italy.
Front Endocrinol (Lausanne). 2021 Feb 25;12:610877. doi: 10.3389/fendo.2021.610877. eCollection 2021.
The primary aim of this study was to assess insulin requirements and carbohydrate to insulin ratio (CHO/IR) in normal weight, overweight, and obese pregnant women with type 1 diabetes across early, middle, and late pregnancy.
In this multicenter, retrospective, observational study we evaluated 86 of 101 pregnant Caucasian women with type 1 diabetes under pump treatment. The women were trained to calculate CHO/IR daily by dividing CHO grams of every single meal by insulin units injected. Since the purpose of the study was to identify the CHO/IR able to reach the glycemic target, we only selected the CHO/IR obtained when glycemic values were at target. Statistics: SPSS 20.
We studied 45 normal weight, 31 overweight, and 10 obese women. Insulin requirements increased throughout pregnancy (p < 0.0001 and <0.001 respectively) in the normal and overweight women, while it remained unchanged in the obese women. Insulin requirements were different between groups when expressed as an absolute value, but not when adjusted for body weight. Breakfast CHO/IR decreased progressively throughout pregnancy in the normal weight women, from 13.3 (9.8-6.7) at the first stage of pregnancy to 6.2 (3.8-8.6) (p = 0.01) at the end stage, and in the overweight women from 8.5 (7.1-12.6) to 5.2 (4.0-8.1) (p = 0.001), while in the obese women it remained stable, moving from 6.0 (5.0-7.9) to 5.1 (4.1-7.4) (p = 0.7). Likewise, lunch and dinner CHO/IR decreased in the normal weight and overweight women (p < 0.03) and not in the obese women. The obese women gained less weight than the others, especially in early pregnancy when they even lost a median of 1.25 (-1 -1.1) kg (p = 0.005). In early pregnancy, we found a correlation between pregestational BMI and insulin requirements (IU/day) or CHO/IR at each meal (p < 0.001 and p = 0.001, respectively). In late pregnancy, a relationship between pre-gestational BMI and CHO/IR change was found (P = 0.004), as well as between weight gain and CHO/IR change (p=0.02). The significance was lost when both variables were included in the multiple regression analysis. There was no difference in pregnancy outcomes except for a higher pre-term delivery rate in the obese women.
Pre-gestational BMI and weight gain may play a role in determining CHO/IR during pregnancy in women with type 1 diabetes under pump treatment.
本研究的主要目的是评估 1 型糖尿病正常体重、超重和肥胖孕妇在妊娠早、中、晚期的胰岛素需求和碳水化合物与胰岛素比值（CHO/IR）。
在这项多中心、回顾性、观察性研究中，我们评估了 101 名接受泵治疗的高加索裔 1 型糖尿病孕妇中的 86 名。这些女性接受了培训，以便通过每餐的每克碳水化合物除以注射的胰岛素单位来计算每日的 CHO/IR。由于本研究的目的是确定能够达到血糖目标的 CHO/IR，因此我们仅选择了当血糖值达到目标时获得的 CHO/IR。统计分析：SPSS 20。
我们研究了 45 名正常体重、31 名超重和 10 名肥胖的女性。在正常体重和超重女性中，胰岛素需求在整个孕期均增加（p<0.0001 和 <0.001），而在肥胖女性中则保持不变。当以绝对值表示时，各组之间的胰岛素需求存在差异，但当按体重调整时则无差异。正常体重女性的早餐 CHO/IR 在整个孕期逐渐下降，从妊娠早期的 13.3（9.8-6.7）降至末期的 6.2（3.8-8.6）（p=0.01），超重女性从 8.5（7.1-12.6）降至 5.2（4.0-8.1）（p=0.001），而肥胖女性则保持稳定，从 6.0（5.0-7.9）降至 5.1（4.1-7.4）（p=0.7）。同样，正常体重和超重女性的午餐和晚餐 CHO/IR 也有所下降（p<0.03），而肥胖女性则没有。肥胖女性的体重增加较少，尤其是在妊娠早期，她们甚至平均减轻了 1.25（-1-1.1）kg（p=0.005）。在妊娠早期，我们发现孕前 BMI 与每餐的胰岛素需求（IU/天）或 CHO/IR 之间存在相关性（p<0.001 和 p=0.001）。在妊娠晚期，发现孕前 BMI 与 CHO/IR 变化之间存在关系（P=0.004），以及体重增加与 CHO/IR 变化之间的关系（p=0.02）。当将两个变量纳入多元回归分析时，这种相关性就消失了。除了肥胖女性的早产率较高外，妊娠结局没有差异。
在接受泵治疗的 1 型糖尿病女性中，孕前 BMI 和体重增加可能在孕期 CHO/IR 中起作用。
