INTRODUCTION An adverse intrauterine environment in early pregnancy in women with type 1 diabetes is associated with several perinatal complications including spontaneous abortions, fetal congenital defects, and preeclampsia.ObjECTIvEs We compared metabolic parameters in the first trimester of pregnancy between women with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) and those treated with multiple daily injections (MDI).PATIENTs AND mEThODs A total of 168 women in the first trimester of pregnancy (33 using CSII and 135 using MDI) were enrolled in this cross-sectional single-center study. Anthropometric parameters, fasting serum levels of hemoglobin A 1c (HbA 1c ), lipid profile, and estimated glucose disposal rate (eGDR) were determined.
REsULTsPatients did not differ in gestational or maternal age, diabetes duration, and the frequency of planned pregnancies. Women using CSII before pregnancy had lower body mass index and waist-to-hip ratio than those using MDI (22.3 vs 23.3 and 0.77 vs 0.79, respectively, P = 0.01). A similar number of women had hypertension; however, the CSII group had lower diastolic blood pressure (P = 0.02). Moreover, the CSII group had a significantly lower insulin requirement (0.54 vs 0.63 units/kg; P = 0.02), significantly higher eGDR (11.3 vs 10.5 mg/kg/min; P = 0.0007), and significantly lower serum triglyceride levels (53.1 vs 61.8 mg/dl; P = 0.004). In a multiple regression analysis, CSII therapy was associated with higher eGDR, lower HbA 1c , and lower serum triglyceride levels.CONCLUsIONs The use of CSII before pregnancy in patients with type 1 diabetes is associated with better metabolic profile in the first trimester.
ORIGINAL ARTICLEAssociation between preconceptional treatment with insulin pumps and improved metabolic status in early pregnancy in women with type 1 diabetes Paweł Gutaj, Agnieszka Zawiejska, Jacek Brązert, Ewa Wender-Ożegowska (7 patients). Two patients refused to participate in the study.All study participants were Caucasians. They were all treated with functional intensive therapy before pregnancy; 135 patients received MDI and 33-CSII. All CSII users had been using this method of therapy for at least 6 months. A basal-bolus protocol used in patients on MDI involved 3 injections of short-acting insulin analog before meals and 1 or 2 injections of intermediate-acting insulin at bedtime or at bedtime and in the morning. Women on CSII received short-acting insulin analog (continuous basal rate and 3 premeal boluses).Of all patients, 61 women using MDI and 20 women using CSII received prepregnancy counseling delivered by a diabetologist or an obstetrician with a special interest in diabetic pregnancy. These data were self-reported by participants. The remaining women received standard care for nonpregnant patients with type 1 diabetes delivered by diabetologists as recommended by the PTD. According to the PTD, blood glucose and HbA 1c targets for women planning their pregnancies or already pregnant compared with those nonp...