Howorka K, Pumprla J, Feiks A, Schlusche C, Nowotny C, Ulm M, Schober E, Bernaschek G
Arbeitsgruppe funktionelle Rehabilitation und Gruppenschulung, Institut für Biomedizinische Technik und Physik, Universität Wien.
Geburtshilfe Frauenheilkd. 1996 Jan;56(1):41-9. doi: 10.1055/s-2007-1023247.
Functional insulin treatment based on the patient's education for selective use of insulin for fasting, eating or correction of hyperglycaemia was used between 1985 and 1994 prospectively in 58 pregnancies (in 18 cases after conception) in 47 pregnant diabetic patients. We hypothesised that near-normalisation of glycaemia is possible throughout pregnancy by modular outpatient group education, individual counselling and functional insulin treatment. We wanted to investigate to which degree it might eliminate classical diabetes-associated neonatal complications. To avoid hospitalisation if possible and premature induction of labour, patients were taught both the primary adjustment (immediate correction of hyperglycaemia) and the secondary adjustment of the insulin dosages: correction of individual algorithms for insulin use according to daily insulin consumption and mean blood glucose MBG. A target metabolic control (HbA1c levels in the normal range, MBG < 100 and < 90 mg/dl after the 28th week of gestation respectively) was achieved in the majority of the 58 pregnancies. Severe hypoglycaemia occurred in 12 patients (21%). The gestational age at delivery was 39.0 +/- 1.6 (34-41; in 3 cases only [5%] < 37) weeks with an average birth weight of 3335 +/- 521 (1950-4450) g. The birth weight of only 5 newborn (9%) was above the 90th percentile and no one below the 10th percentile for weight of a comparable population. No cases of respiratory distress were observed. Hypoglycaemia was recorded in only 4 newborn (7%) and was comparable also to that of offsprings in non-diabetic women. Malformations were found in two offsprings whose mothers had presented first for diabetes education after conception, pregnancy being terminated in one case of meningomyelocele. Caesarean section (n = 15; 26%) was primarily due to maternal reasons. Functional insulin treatment prior to conception, modular diabetes group education, specific patient motivation for a near-normal glycaemia throughout pregnancy as well as interdisciplinary care allow pregnancy outcome in diabetic patients similar to that in non-diabetic women and thus the realisation of the 5-year targets of the WHO Declaration of St. Vincent 1989.
1985年至1994年期间，对47例妊娠糖尿病患者的58次妊娠（18例为受孕后）前瞻性地采用了基于患者教育的功能性胰岛素治疗，以选择性地使用胰岛素来控制空腹、进食或纠正高血糖。我们假设通过模块化门诊小组教育、个体化咨询和功能性胰岛素治疗，整个孕期血糖有可能接近正常化。我们想研究它在多大程度上可以消除典型的糖尿病相关新生儿并发症。为尽可能避免住院和早产引产，对患者进行了胰岛素剂量的初级调整（立即纠正高血糖）和次级调整的培训：根据每日胰岛素消耗量和平均血糖（MBG）校正个体胰岛素使用算法。在58例妊娠中的大多数实现了目标代谢控制（糖化血红蛋白A1c水平在正常范围内，妊娠28周后MBG分别<100和<90mg/dl）。12例患者（21%）发生严重低血糖。分娩时的孕周为39.0±1.6（34 - 41；仅3例[5%]<37）周，平均出生体重为3335±521（1950 - 4450）g。只有5例新生儿（9%）的出生体重高于可比人群体重的第90百分位数，没有一例低于第10百分位数。未观察到呼吸窘迫病例。仅4例新生儿（7%）记录到低血糖，这也与非糖尿病女性后代的情况相当。在两名后代中发现畸形，其母亲在受孕后首次接受糖尿病教育，其中一例因脊髓脊膜膨出终止妊娠。剖宫产（n = 15；26%）主要是由于母体原因。受孕前的功能性胰岛素治疗、模块化糖尿病小组教育、患者在整个孕期实现血糖接近正常的特定动机以及多学科护理，使糖尿病患者的妊娠结局与非糖尿病女性相似，从而实现了1989年世界卫生组织圣文森特宣言的5年目标。
