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Intensive Glycemic Treatment During Type 1 Diabetes Pregnancy: A Story of (Mostly) Sweet Success!
- Source :
-
Diabetes care [Diabetes Care] 2018 Aug; Vol. 41 (8), pp. 1563-1571. Date of Electronic Publication: 2018 Jun 23. - Publication Year :
- 2018
-
Abstract
- Studies from Scotland and Canada confirm large increases in the incidence of pregnancies complicated by pregestational type 1 diabetes (T1D). With this increased antenatal workload comes more specialization and staff expertise, which may be important as diabetes technology use increases. While euglycemia remains elusive and obstetrical intervention (earlier delivery, increased operative deliveries) is increasing, there have been some notable successes in the past 5-10 years. These include a decline in the rates of congenital anomaly (Canada) and stillbirths (U.K.) and substantial reductions in both maternal hypoglycemia (both moderate and severe) across many countries. However, pregnant women with T1D still spend ∼30-45% of the time (8-11 h/day) hyperglycemic during the second and third trimesters. The duration of maternal hyperglycemia appears unchanged in routine clinical care over the past decade. This ongoing fetal exposure to maternal hyperglycemia likely explains the persistent rates of large for gestational age (LGA), neonatal hypoglycemia, and neonatal intensive care unit (NICU) admissions in T1D offspring. The Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT) found that pregnant women using real-time continuous glucose monitoring (CGM) spent 5% less time (1.2 h/day) hyperglycemic during the third trimester, with clinically relevant reductions in LGA, neonatal hypoglycemia, and NICU admissions. This article will review the progress in our understanding of the intensive glycemic treatment of T1D pregnancy, focusing in particular on the recent technological advances in CGM and automated insulin delivery. It suggests that even with advanced diabetes technology, optimal maternal dietary intake is needed to minimize the neonatal complications attributed to postprandial hyperglycemia.<br /> (© 2018 by the American Diabetes Association.)
- Subjects :
- Adult
Blood Glucose drug effects
Blood Glucose Self-Monitoring methods
Diabetes Mellitus, Type 1 epidemiology
Female
Humans
Hypoglycemia chemically induced
Hypoglycemia epidemiology
Insulin therapeutic use
Pregnancy
Pregnancy Complications drug therapy
Pregnancy Complications epidemiology
Pregnancy Outcome epidemiology
Pregnancy in Diabetics epidemiology
Treatment Outcome
Blood Glucose metabolism
Diabetes Mellitus, Type 1 blood
Diabetes Mellitus, Type 1 drug therapy
Hypoglycemic Agents therapeutic use
Pregnancy in Diabetics blood
Pregnancy in Diabetics drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1935-5548
- Volume :
- 41
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Diabetes care
- Publication Type :
- Academic Journal
- Accession number :
- 29936423
- Full Text :
- https://doi.org/10.2337/dci18-0001