Tamura Rie Kaneshima, Kodani Noriko, Itoh Arata, Meguro Shu, Kajio Hiroshi, Itoh Hiroshi
Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi Shinjuku-Ku, Tokyo, 160-8582 Japan.
Department of Diabetes, Endocrinology and Metabolism, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-Ku, Tokyo, 162-8655 Japan.
Diabetol Int. 2024 Mar 30;15(3):447-455. doi: 10.1007/s13340-024-00716-7. eCollection 2024 Jul.
It is challenging for pregnant women with type 1 diabetes to maintain optimum glucose level to attain good neonatal outcomes. This study evaluated the efficacy of sensor-augmented insulin pump (SAP) with a predictive low-glucose suspend (PLGS) system in pregnant Japanese women with type 1 diabetes.
SAP with PLGS was used in 11 of the 22 women with type 1 diabetes who delivered between 2011 and 2021 at the two medical institutions in Japan. Glucose management, insulin delivery suspension time (IST) and neonatal outcomes were retrospectively studied.
In SAP with PLGS cases ( = 11), average glycated hemoglobin levels were < 6.5% throughout the pregnancy, and the time in range (TIR, 63-140 mg/dl) was > 70% in the second and third trimesters. PLGS was safely used without inducing ketoacidosis. Positive correlation was observed between IST and TIR ( = 0.62, < 0.01). Negative correlation was observed between IST and time below range (TBR) ( = - 0.40, = 0.02), and IST and time above range (TAR) ( = - 0.45, = 0.01). Total daily insulin dose was adequately increased without increasing hypoglycemia. There was only one heavy-for-date HFD) infant among the 11 newborns in SAP with PLGS cases. In cases without SAP ( = 11), target glycemic levels were difficult to achieve and there were 5 HFD infants among the 11 newborns.
SAP with PLGS was safely and effectively used in pregnant women with type 1 diabetes to achieve target glucose levels without increasing the risk of hypoglycemia, which may have led to good neonatal outcomes.
The online version contains supplementary material available at 10.1007/s13340-024-00716-7.
1型糖尿病孕妇要维持最佳血糖水平以获得良好的新生儿结局具有挑战性。本研究评估了带有预测性低血糖暂停（PLGS）系统的传感器增强胰岛素泵（SAP）在日本1型糖尿病孕妇中的疗效。
在日本两家医疗机构2011年至2021年间分娩的22例1型糖尿病女性中，11例使用了带有PLGS的SAP。对血糖管理、胰岛素输注暂停时间（IST）和新生儿结局进行了回顾性研究。
在使用带有PLGS的SAP的病例（n = 11）中，整个孕期糖化血红蛋白平均水平<6.5%，孕中期和孕晚期血糖在目标范围内的时间（TIR，63 - 140mg/dl）>70%。PLGS使用安全，未诱发酮症酸中毒。IST与TIR之间呈正相关（r = 0.62，P < 0.01）。IST与血糖低于目标范围的时间（TBR）之间呈负相关（r = -0.40，P = 0.02），IST与血糖高于目标范围的时间（TAR）之间呈负相关（r = -0.45，P = 0.01）。每日胰岛素总剂量适当增加，且未增加低血糖发生率。在使用带有PLGS的SAP的11例新生儿中，只有1例为大于胎龄儿（HFD）。在未使用SAP的病例（n = 11）中，难以达到目标血糖水平，11例新生儿中有5例为HFD婴儿。
带有PLGS的SAP在1型糖尿病孕妇中安全有效使用，可实现目标血糖水平，且不增加低血糖风险，这可能带来了良好的新生儿结局。
在线版本包含可在10.1007/s13340 - 024 - 00716 - 7获取的补充材料。
