1 型糖尿病孕妇使用胰岛素泵治疗期间的胰岛素需求。

Insulin requirements during pregnancy in women with type 1 diabetes treated with insulin pump.

机构信息

Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

Diabetes Metab Res Rev. 2024 Mar;40(3):e3771. doi: 10.1002/dmrr.3771.

DOI:10.1002/dmrr.3771

PMID:38404019

Abstract

INTRODUCTION

Insulin requirement in women with Type 1 diabetes (T1DM) changes throughout pregnancy. The aim of this study was to determine the total change in insulin requirements and the effect of gestational weight gain (GWG) and pre-gestational BMI on insulin requirements during pregnancy in women with T1DM treated with continuous subcutaneous insulin infusion and continuous glucose monitoring.

METHODS

This historical cohort study included all consecutive women with T1DM who were monitored during pregnancy at the high-risk pregnancy clinic at a tertiary medical center during April 2011-April 2019. One Way Repeated Measures ANOVA with Bonferroni adjustment was conducted to compare the effects of gestational age on insulin requirements and a Two Way Repeated Measures ANOVA was employed to test for the interaction between gestational age intervals and maternal BMI and GWG.

RESULTS

Data regarding insulin requirements of 185 pregnancies were included in the analyses. There was a significant effect of gestational age on total insulin (Wilks' Lambda = 0.34, F(6,14) = 4.52, p = 0.009), basal insulin (Wilks' Lambda = 0.41, F(6,14) = 3.30, p = 0.031) and bolus insulin (Wilks' Lambda = 0.43, F(6,14) = 3.02, p = 0.041). Total insulin/kg requirements increased by 5.5% from 13-20 weeks to 20-26 weeks, 19% from 20-26 weeks to 26-33 weeks, and 17.4% from 26 to 33 weeks to delivery (p for trend = 0.009). Overall, insulin requirements increased by 42.1% from conception to delivery (p < 0.01). There was no significant main effect of maternal BMI or GWG on insulin requirements.

CONCLUSIONS

There is a significant increase in insulin requirements per kg during pregnancy in women with T1DM who were treated with an insulin pump.

摘要

简介

1 型糖尿病（T1DM）女性在整个怀孕期间的胰岛素需求会发生变化。本研究的目的是确定胰岛素需求量的总变化，以及在接受持续皮下胰岛素输注和连续血糖监测的 T1DM 女性中，妊娠体重增加（GWG）和孕前 BMI 对妊娠期间胰岛素需求的影响。

方法

这是一项历史性队列研究，纳入了 2011 年 4 月至 2019 年 4 月期间在一家三级医疗中心的高危妊娠诊所接受监测的所有连续 T1DM 女性。采用单向重复测量方差分析（Bonferroni 调整）比较了孕龄对胰岛素需求的影响，采用双向重复测量方差分析检验了孕龄间隔与母体 BMI 和 GWG 之间的相互作用。

结果

185 例妊娠的胰岛素需求数据纳入了分析。孕龄对总胰岛素（Wilks' Lambda=0.34，F(6,14)=4.52，p=0.009）、基础胰岛素（Wilks' Lambda=0.41，F(6,14)=3.30，p=0.031）和餐时胰岛素（Wilks' Lambda=0.43，F(6,14)=3.02，p=0.041）的需求有显著影响。从 13-20 周至 20-26 周，总胰岛素/kg 需求量增加了 5.5%，从 20-26 周至 26-33 周增加了 19%，从 26 周至 33 周分娩时增加了 17.4%（趋势 p=0.009）。总体而言，从受孕到分娩，胰岛素需求量增加了 42.1%（p<0.01）。母体 BMI 或 GWG 对胰岛素需求没有显著的主要影响。