Department of Clinical and Experimental Medicine, University of Pisa, Italy.
Department of Medicine, University Hospital of Pisa, Italy.
Diabetes Res Clin Pract. 2023 Nov;205:110979. doi: 10.1016/j.diabres.2023.110979. Epub 2023 Oct 25.
Over the recent years multiple therapeutic and management opportunities have been made available to treat pregnant women with Type 1 diabetes (T1DM). However, analyses assessing whether these different approaches may have any specific advantage/disadvantage in metabolic control and neonatal outcomes is still limited. The aim of this study was to compare metabolic control and neonatal outcomes in pregnant women with T1DM among different basal insulins (NPH vs. analogue), insulin administration ways [Multiple Daily Injections (MDI) vs. Continuous Subcutaneous Insulin Infusion (CSII)] and glucose monitoring systems [Self-Monitoring of Blood Glucose (SMBG) vs. real-time/intermittently scanned Continuous Glucose Monitoring (rtCGM/isCGM)].
A retrospective analysis on metabolic data and neonatal outcomes of 136 T1DM pregnant women (76% on MDI, based on NPH (51%) or analogue (49%); 24% on CSII; 24% using rtCGM/isCGM), managed between 2008 and 2020, was performed, comparing different therapeutic approaches.
Metabolic data and neonatal outcomes were comparable among women treated with different basal insulins. Women on CSII planned their pregnancy more frequently (82 vs. 60%; p = 0.043) and had better pregestational HbA1c (52 ± 5 vs. 60 ± 13 mmol/mol; p = 0.044) and first trimester HbA1c (48 ± 4 vs. 51 ± 8 mmol/mol; p = 0.047). Pregestational and first trimester HbA1c were also lower in women using rtCGM/isCGM (53 ± 8 vs. 58 ± 13 mmol/mol; p = 0.027 and 46 ± 5 vs. 51 ± 7 mmol/mol; p = 0.034, respectively). In the whole cohort, LGA risk was directly correlated to HbA1c at third trimester (correlation coefficient: 0.335, p = 0.001) and inversely correlated to the achievement of HbA1c target (≤6% [<42 mmol/mol]) at third trimester (correlation coefficient: - 0.367, p < 0.001).
Treatment with insulin analogs didn't significantly change metabolic control and neonatal outcomes in T1DM women, while CSII and rtCGM/isCGM can optimize preconception and first trimester pregnancy glycemic control. Irrespective of the therapeutic management, third trimester HbA1c remains the strongest risk factor for LGA.
近年来，为治疗 1 型糖尿病（T1DM）孕妇，出现了多种治疗和管理机会。然而，评估这些不同方法在代谢控制和新生儿结局方面是否具有特定优势/劣势的分析仍然有限。本研究的目的是比较不同基础胰岛素（NPH 与类似物）、胰岛素给药方式[多次皮下注射（MDI）与连续皮下胰岛素输注（CSII）]和血糖监测系统[自我监测血糖（SMBG）与实时/间歇性扫描连续血糖监测（rtCGM/isCGM）]在 T1DM 孕妇中的代谢控制和新生儿结局。
对 2008 年至 2020 年间管理的 136 名 T1DM 孕妇（76%使用 MDI，基于 NPH（51%）或类似物（49%）；24%使用 CSII；24%使用 rtCGM/isCGM）的代谢数据和新生儿结局进行了回顾性分析，比较了不同的治疗方法。
使用不同基础胰岛素的女性在代谢数据和新生儿结局方面无差异。CSII 组女性更频繁地计划妊娠（82% vs. 60%；p=0.043），且孕前和孕早期糖化血红蛋白（HbA1c）水平更低（52±5 vs. 60±13mmol/mol；p=0.044 和 48±4 vs. 51±8mmol/mol；p=0.047）。使用 rtCGM/isCGM 的女性孕前和孕早期 HbA1c 也较低（53±8 vs. 58±13mmol/mol；p=0.027 和 46±5 vs. 51±7mmol/mol；p=0.034）。在整个队列中，巨大儿（LGA）风险与孕晚期 HbA1c 呈直接相关（相关系数：0.335，p=0.001），与孕晚期 HbA1c 达标（≤6%[＜42mmol/mol]）呈负相关（相关系数：-0.367，p＜0.001）。
T1DM 女性使用胰岛素类似物并不会显著改变代谢控制和新生儿结局，而 CSII 和 rtCGM/isCGM 可以优化孕前和孕早期的血糖控制。无论治疗管理如何，孕晚期 HbA1c 仍然是 LGA 的最强风险因素。
