To investigate whether the incidence of severe hypoglycaemia in pregnant women with type 1 diabetes can be reduced without deteriorating HbA1c levels or pregnancy outcomes in a routine care setting.
Two cohorts (2004–2006; n = 108 and 2009–2011; n = 104) were compared. In between the cohorts a focused intervention including education of caregivers and patients in preventing hypoglycaemia was implemented. Women were included at median 8 (range 5–13) weeks. Severe hypoglycaemia (requiring assistance from others) was prospectively reported in structured interviews.
In the first vs. second cohort, severe hypoglycaemia during pregnancy occurred in 45% vs. 23%, p = 0.0006, corresponding to incidences of 2.5 vs. 1.6 events/patient-year, p = 0.04. Unconsciousness and/or convulsions occurred at 24% vs. 8% of events. Glucagon and/or glucose injections were given at 15% vs. 5% of events. At inclusion HbA1c was comparable between the cohorts while in the second cohort fewer women reported impaired hypoglycaemia awareness (56% vs. 36%, p = 0.0006), insulin dose in women on multiple daily injections was lower (0.77 IU/kg (0.4–1.7) vs. 0.65 (0.2–1.4), p = 0.0006) and more women were on insulin analogues (rapid-acting 44% vs. 97%, p < 0.0001; long-acting 6% vs. 76%, p < 0.0001) and insulin pumps (5% vs. 23%, p < 0.0001). Pregnancy outcomes were similar in the two cohorts.
A 36% reduction in the incidence of severe hypoglycaemia in pregnancy with unchanged HbA1c levels and pregnancy outcomes was observed after implementation of focused intervention against severe hypoglycaemia in a routine care setting. Improved insulin treatment, increased health professional education and fewer women with impaired hypoglycaemia awareness may contribute.
Abbreviations:CGM (continuous glucose monitoring), SMPG (self-monitored plasma glucose)
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Published online: July 02, 2013
Accepted: June 6, 2013
Received in revised form: May 22, 2013
Received: March 23, 2013
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.