Advances in diabetes management: have pregnancy outcomes in women with type 1 diabetes changed in the last decades?

Citro, F; Bianchi, C; Nicolì, F; Aragona, M; Marchetti, P; Di Cianni, G; Bertolotto, A

doi:10.1016/j.diabres.2023.110979

Type 1 diabetes

Advances in diabetes management: have pregnancy outcomes in women with type 1 diabetes changed in the last decades?

Diabetes Res Clin PractPublished 25 Oct 2023Retrospective cohort study

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Authors' conclusion

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.

Study context

Population: Pregnant women with T1D managed 2008–2020; 76% on Multiple Daily Injections (MDI) (NPH 51%, analogue 49%), 24% on Continuous Subcutaneous Insulin Infusion (CSII), 24% using rtCGM/isCGM
Participants: 136 women

Exposure: NPH vs analogue basal insulin; MDI vs CSII; Self-Monitoring of Blood Glucose (SMBG) vs rtCGM/isCGM
Outcome: Metabolic control and neonatal outcomes by basal insulin, insulin administration and glucose monitoring

Main finding

As reported in the abstract

Metabolic control and neonatal outcomes by treatment approach

Metabolic data and neonatal outcomes were comparable among women treated with different basal insulins

Observational data: associations, not effects.

Further findings

CSII vs MDI

Planned pregnancy (CSII vs MDI)

P = 0.043

CSII82%

MDI60%

Pregestational HbA1c (CSII vs MDI)

P = 0.044

CSII52 ± 5 mmol/mol

MDI60 ± 13 mmol/mol

First trimester HbA1c (CSII vs MDI)

P = 0.047

CSII48 ± 4 mmol/mol

MDI51 ± 8 mmol/mol

rtCGM/isCGM vs SMBG

Pregestational HbA1c (rtCGM/isCGM vs SMBG)

P = 0.027

rtCGM/isCGM53 ± 8 mmol/mol

SMBG58 ± 13 mmol/mol

First trimester HbA1c (rtCGM/isCGM vs SMBG)

P = 0.034

rtCGM/isCGM46 ± 5 mmol/mol

SMBG51 ± 7 mmol/mol

LGA risk vs third trimester HbA1c (whole cohort)

Correlation of LGA risk with third trimester HbA1c (correlation coefficient), p = 0.001: 0.335
Correlation of LGA risk with achieving HbA1c target ≤6% [<42 mmol/mol] at third trimester (correlation coefficient), p < 0.001: - 0.367

Original publication

Advances in diabetes management: have pregnancy outcomes in women with type 1 diabetes changed in the last decades? Diabetes Res Clin Pract. Published 25 October 2023. doi:10.1016/j.diabres.2023.110979

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