Abstract: SAT 593

Glucose Variability during Pregnancy in Women with Type 1 Diabetes on Insulin Pumps 

Presenter: Vikash Dadlani, M.B.B.S.


Abstract


Pregnancy is associated with fetal and maternal morbidity in patients with type 1 diabetes (T1D). Tight blood glucose (BG) control during pregnancy has been shown to decrease in congenital malformation, stillbirth and neonatal death. Continuous glucose monitors (CGM), insulin pumps or continuous subcutaneous insulin infusion (CSII) and combination of CGM and CSII especially closed loop control are achieving tight and safer glucose control in non-pregnant T1D populations but have not been tested enough in pregnant T1D patients. view more

Pregnancy is associated with fetal and maternal morbidity in patients with type 1 diabetes (T1D). Tight blood glucose (BG) control during pregnancy has been shown to decrease in congenital malformation, stillbirth and neonatal death. Continuous glucose monitors (CGM), insulin pumps or continuous subcutaneous insulin infusion (CSII) and combination of CGM and CSII especially closed loop control are achieving tight and safer glucose control in non-pregnant T1D populations but have not been tested enough in pregnant T1D patients. We evaluated glucose variability (GV) in T1D on CSII to facilitate design of future studies. Data was collected from seventeen pregnant women with T1D (9 from Mayo Clinic and 8 from Mount Sinai), age 29.1 ± 4.23 years, HbA1c 6.3 ± 0.71% on CSII during pregnancy. GV was measured with multiple measures including mean plasma glucose, standard deviation, high blood glucose index (HBGI), low blood glucose index (LBGI) and average daily risk range (ADRR). The mean BG was 128.4 ± 50.3 mg/dl. The mean number of BG readings was 1338 ± 822 during this period with average number of readings 9 ± 3 per day. 72% of the readings were in range between 70 to 180mg/dl with 11.9 % below 70mg/dl and 16.2 % above 180mg/dl. ADRR was 24 ± 7.1 with LBGI 2.8 ± 1.4 and HBGI 3.7 ± 2.7. We also analyzed CGM data in 12 subjects during this same period. Mean number of reading per day during the time subjects were on CGM was 238 and mean CGM glucose was 121.5 ± 41.4 mg/dl with 82 % of the readings in range between 70 to 180mg/dl and 9.1% and 9.3 %of CGM readings below <70mg/dl and above 180mg/dl, respectively. ADRR was 31 ± 10 with LBGI of 2.3 ± 1.2 and HBGI of 2.32 ± 1.21. Pregnant women with T1D work hard to maintain tight glucose control. In spite of this, the burden of hypoglycemia during pregnancy is high with current technologies. Therefore, new therapies such as closed-loop control in this context need to be developed and tested.

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