Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/118904
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Type: Journal article
Title: Pregnancy outcomes and insulin requirements in women with type 1 diabetes treated with continuous subcutaneous insulin infusion and multiple daily injections: cohort study
Author: Abell, S.
Suen, M.
Pease, A.
Boyle, J.
Soldatos, G.
Regan, J.
Wallace, E.
Teede, H.
Citation: Diabetes Technology and Therapeutics, 2017; 19(5):280-287
Publisher: Mary Ann Liebert
Issue Date: 2017
ISSN: 1520-9156
1557-8593
Statement of
Responsibility: 
Sally K. Abell, Matthew Suen, Anthony Pease, Jacqueline A. Boyle, Georgia Soldatos, John Regan, Euan M. Wallace and Helena J. Teede
Abstract: Background: We aimed to compare glycemic control, insulin requirements, and outcomes in women with type 1 diabetes in pregnancy treated with continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI). Methods: A retrospective cohort study was conducted of singleton pregnancies (>20 weeks gestation) in women with type 1 diabetes (2010–2015) at a specialist multidisciplinary maternity network in Australia. Antenatal characteristics, diabetes history and treatment details, and maternal and neonatal outcomes were compared for women with type 1 diabetes using CSII and MDI. Bolus calculator settings were reviewed for CSII. Data were obtained from individual medical records, linkage to pathology, and the Birthing Outcomes System database. Results: There were no differences in maternal characteristics or diabetes history between women managed with CSII (n = 40) and MDI (n = 127). Women treated with CSII required less insulin and less increase in total daily insulin dose/kg than MDI (40% vs. 52%). Both groups achieved similar glycemic control and no differences in pregnancy outcome. In the CSII group, carbohydrate:insulin ratios were intensified across gestation (30% breakfast, 27% lunch, 22% dinner), and insulin sensitivity factors (ISFs) changed little (7% breakfast, 0% lunch, −10% dinner). Conclusions: There was no difference in glycemic control or pregnancy outcomes in women using CSII or MDI managed in a multidisciplinary setting. Greater adjustments are needed to ISFs with CSII therapy. Overall, these data do not support recommending CSII in pregnancy with potentially higher patient and staff demands and costs and lack of improvement in HbA1c and pregnancy outcomes.
Keywords: Humans
Pregnancy in Diabetics
Diabetes Mellitus, Type 1
Hyperglycemia
Hypoglycemia
Insulin
Hypoglycemic Agents
Pregnancy Outcome
Insulin Infusion Systems
Injections, Subcutaneous
Drug Administration Schedule
Retrospective Studies
Cohort Studies
Reproducibility of Results
Pregnancy
Adult
Hospitals, University
Patient Care Team
Victoria
Female
Infusions, Subcutaneous
Glycated Hemoglobin A
Rights: © 2017, Mary Ann Liebert, Inc.
DOI: 10.1089/dia.2016.0412
Grant ID: NHMRC
Appears in Collections:Aurora harvest 4
Obstetrics and Gynaecology publications

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