Intensive Metabolic Control of T1D Pregnant Women in CSII vs. MDI—A Retrospective Analysis

Abstract

Diabetes-complicated pregnancy requires intensive gluco-metabolic monitoring. There is no clear evidence that insulin pump therapy (CSII) is superior to multiple daily injections with insulin analogs (MDI) in achieving tight glycemic control. We conducted a retrospective analysis on 72 (69 singles and 3 twins) T1D pregnant women, followed at the Diabetes and Pregnancy Unit (University Hospital, Perugia) since the first weeks of gestation or before conception. Maternal metabolic parameters (HbA1c, mean BG, weight gain, prandial and basal insulin needs and percentage increase in insulin requirement, I:CHO ratio) at conception, and each trimester, were assessed. Finally, neonatal outcomes (birth weight, newborn age, neonatal complications-malformations incidence) were analyzed. We compared the data with regard to applied regimens (CSII vs. MDI). 28 women were on CSII (38.8%) and 44 on MDI therapy, with mean HbA1c at conception of 7.1 ± 0.7% vs. 7.2 ± 1.2%, respecively (P> 0.05). Women who received pre-conceptional counseling (56% of CSII women vs. 13% of MDI), showed significantly lower HbA1c at conception (6.7 ± 0.6 vs. 7.3 ± 1.1, p <0.05). Disease duration, previous abortion rate and prevalence of chronic complications (class D-G, White classification) were significantly higher in CSII group. In single pregnancies, no significant differences were observed, in CSII vs. MDI, as far as HbA1c, insulin (U/Kg), percentage increase of insulin requirement, I:CHO ratio, weight increase, gestation term, birth weight, prevalence of maternal and neonatal complications were concerned (p> 0.05). CSII was not proved superior to MDI in the management of pregnancy, in terms of neither maternal insulin requirements nor of maternal-fetal outcomes. Intensive management of diabetic pregnancy ensures stringent glycemic control, regardless of treatment with CSII or MDI. The choice of treatment modality should be targeted on pre-gestational and individual parameters. Disclosure S. Parrettini: None. I. Giardina: None. F. Cardini: None. E. Torlone: Other Relationship; Self; Medtronic MiniMed, Inc., Novo Nordisk Inc., Eli Lilly and Company, Roche Diabetes Care Health and Digital Solutions, Sanofi-Aventis, Menarini Group.