Risk factors of pathological glycemic variability in pregnant women with type 1 diabetes mellitus

Abstract

Hypothesis/aims of study. Academician Vasily G. Baranov’s statement that achieving normal glycemia is the main condition for successful pregnancy outcomes in women with diabetes mellitus has already been proven. Unfortunately, these tight glycemic targets are hard to be achieved especially in metabolic changes during pregnancy. Glycemic variability is a new glycemic parameter available due to continuous glucose monitoring (CGM). Pathological glycemic variability can be an important risk factor for oxidative stress along with chronic hyperglycemia in patients with type 1 diabetes mellitus (T1D). However, there is no enough literature confirming the effect of pathological glycemic variability on pregnancy course and outcomes in T1D women. The aim of the study is to analyze different modes of insulin therapy for glycemic targets achievement and glycemic variability reduction in T1D pregnant women.
 Study design, materials, and methods. 100 women treated with continuous subcutaneous insulin infusion (CSII) and another 100 women treated with multiple daily injections (MDI) of insulin were examined. Indices of glycemic variability were estimated.
 Results. Glycemic variability was significantly lower in CSII patients compared to the MDI group. The influence of glycemic variability on endothelial dysfunction was confirmed for T1D pregnant women. CSII proved advantages in achieving glycemic targets without increasing glycemic variability and hypoglycemia.
 Conclusion. CSII combined with CGM is the most optimal insulin therapy for glycemic targets achievement without an increased risk for glycemic variability and hypoglycemia.