Donovan Lois E, Bell Rhonda C, Feig Denice S, Lemieux Patricia, Murphy Helen R, Sigal Ronald J, Ho Josephine, Virtanen Heidi, Crawford Susan, Yamamoto Jennifer M
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Diabetologia. 2024 Oct;67(10):2154-2159. doi: 10.1007/s00125-024-06227-z. Epub 2024 Jul 19.
AIMS/HYPOTHESIS: This study aimed to describe the relationship between breastfeeding episodes and maternal glucose levels, and to assess whether this differs with closed-loop vs open-loop (sensor-augmented pump) insulin therapy.
Infant-feeding diaries were collected at 6 weeks, 12 weeks and 24 weeks postpartum in a trial of postpartum closed-loop use in 18 women with type 1 diabetes. Continuous glucose monitoring (CGM) data were used to identify maternal glucose patterns within the 3 h of breastfeeding episodes. Generalised mixed models adjusted for breastfeeding episodes in the same woman, repeat breastfeeding episodes, carbohydrate intake, infant age at time of feeding and early pregnancy HbA. This was a secondary analysis of data collected during a randomised trial (ClinicalTrials.gov registration no. NCT04420728).
CGM glucose remained above 3.9 mmol/l in the 3 h post-breastfeeding for 93% (397/427) of breastfeeding episodes. There was an overall decrease in glucose at nighttime within 3 h of breastfeeding (1.1 mmol l h decrease on average; p=0.009). A decrease in nighttime glucose was observed with open-loop therapy (1.2 ± 0.5 mmol/l) but was blunted with closed-loop therapy (0.4 ± 0.3 mmol/l; p<0.01, open-loop vs closed-loop).
CONCLUSIONS/INTERPRETATION: There is a small decrease in glucose after nighttime breastfeeding that usually does not result in maternal hypoglycaemia; this appears to be blunted with the use of closed-loop therapy.
目的/假设：本研究旨在描述母乳喂养次数与母亲血糖水平之间的关系，并评估闭环胰岛素治疗与开环（传感器增强泵）胰岛素治疗相比，这种关系是否存在差异。
在一项针对18名1型糖尿病女性产后闭环使用的试验中，于产后6周、12周和24周收集婴儿喂养日记。连续血糖监测（CGM）数据用于识别母乳喂养期间3小时内母亲的血糖模式。采用广义混合模型，对同一女性的母乳喂养次数、重复母乳喂养次数、碳水化合物摄入量、喂养时婴儿年龄和孕早期糖化血红蛋白进行校正。这是对一项随机试验（ClinicalTrials.gov注册号：NCT04420728）期间收集的数据进行的二次分析。
在93%（397/427）的母乳喂养期间，母乳喂养后3小时内CGM血糖保持在3.9 mmol/l以上。母乳喂养后3小时内夜间血糖总体下降（平均每小时下降1.1 mmol/l；p=0.009）。开环治疗时夜间血糖下降（1.2±0.5 mmol/l），但闭环治疗时下降不明显（0.4±0.3 mmol/l；p<0.01，开环与闭环）。
结论/解读：夜间母乳喂养后血糖有小幅下降，通常不会导致母亲低血糖；使用闭环治疗后这种下降似乎不明显。
