Abstract
Objective To assess the efficacy of sensor- augmented insulin- pump (SAP) during the perioperative period of cesarean delivery in patients with gestational diabetes mellitus(GDM). Methods GDM patients with indications of cesarean section were randomized into experimental group and control group according to table of random number between April 2012 to December 2013. The experimental group was treated with continuous subcutaneous insulin infusion (CSII) titrated based on real-time continuous glucose monitoring system (RT-CGMS), while the control group was treated with CSII adjusted by point of care testing (POCT). The level of blood glucose, insulin dosage, incidence of hypoglycemia, incision healing time and neonatal adverse outcomes were compared between two groups. Covariance analysis was used for the related indicators at the day of surgery, and descriptive analysis was used for the analysis of the postoperative related indicators. Results (1) A total of 56 patients were enrolled, 30 in control group and 26 in experimental group. Baseline characteristics of the patients were comparable between two groups. (2) On the day of surgery, basal rate was adjusted more frequently in experimental group according to RT- CGMS. The dose of basal insulin in the experimental group was significantly lower than in the control group ((0.31 ± 0.09) vs (0.38 ± 0.11) U/kg, t=2.62, P=0.03). The frequency of basal rate adjustment was more in the experimental group (56 vs 22, P<0.01). The frequency and incidence of hypoglycemia were lower in the experimental group than in the control group (5 vs 15, 15.4% vs 30%, χ2=4.60, 2.61, both P<0.05). (3) The 24 h insulin dose decreased significantly after childbirth in both groups. Insulin use was ceased in 14 patients of experimental group and 11 of control group. (4) No significant difference were observed in incision healing time and neonatal adverse outcomes between the two groups. Conclusion Sensor-augmented insulin-pump demonstrates unique advantage in controlling blood glucose of perioperative GDM patients. Key words: Diabetes mellitus, gestational; Real-time continuous glucose monitoring system; Perioperative period
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