OR02-6 Insulin Pump Use in Pregnancy is Associated with Better Glycemic Control Without Increasing the Rate of Severe Hypoglycemia or Diabetic Ketoacidosis in Women with Type 1 Diabetes

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: OR02-Diabetes in Pregnancy
Translational
Saturday, June 15, 2013: 11:30 AM-1:00 PM
Presentation Start Time: 12:45 PM
Room 303 (Moscone Center)
Melissa Kallas-Koeman*1, Jason M Kong1, Jennifer Klinke2, Sonia Butalia3, Abhay Lodha3, Kenneth Lim1, Qiuli Duan4 and Lois E Donovan3
1University of British Columbia, Vancouver, BC, Canada, 2University of British Columbia, New Westminster, BC, Canada, 3University of Calgary, Calgary, AB, Canada, 4Alberta Health Services, Calgary, AB, Canada
Background and objective: Pregnancy in women with type 1 diabetes is high risk, but it is unknown whether insulin pump therapy can reduce this risk. Our objective was to compare glycemic control and maternal-fetal outcomes between women with type 1 diabetes managed on the insulin pump versus multiple daily injections of insulin.

Methods: In a retrospective cohort study, we reviewed 387 consecutive pregnancies in women with type 1 diabetes who attended specialized clinics at three centres between 2006-2010. We assessed the average A1c per trimester, metabolic complications, gestational hypertension, weight gain, and cesarean section rate in the mother, and rate of infants large for gestational age (>90%ile), preterm delivery, neonatal hypoglycemia, special/intensive care nursery admission, jaundice requiring phototherapy, congenital anomalies, and perinatal mortality in the offspring.

Results: Women who used the insulin pump (129/387) were older (31.5±4.3 vs. 29.6±5.2 years, p<0.001) and had higher rates of preconception care (45.3 vs. 31.8%, p=0.009), a longer duration of diabetes (17.0±6.6 vs. 12.8±8.4 years, p<0.001), smoked less in pregnancy (5.3 vs. 21.4%, p<0.001), and had more retinopathy (17.1 vs. 8.5%, p=0.006). Among 113 completed pregnancies in women on pumps and 218 in women on multiple daily injections (including 1 and 2 stillbirths, respectively), there was a significant difference in glycemic control in the first trimester (mean A1c 6.9±0.7% vs. 7.6±1.4%, p<0.001) which persisted until the third trimester (mean A1c 6.5±0.5% vs. 6.8±0.9%, p=0.002). Despite tighter glycemic control, women on the pump did not have an increased rate of severe hypoglycemia (8.0 vs. 7.6%, p=0.90). Pump therapy was not associated with an increased risk of diabetic ketoacidosis (1.8 vs. 3.0%, p=0.72). Cesarean section rate was comparable at 69.0 vs. 64.2% (p=0.38), respectively, though women on the pump delivered significantly more large-for-gestational-age infants, at 55.1 vs. 39.2% (p=0.007). The remaining maternal-fetal outcomes were similar.

Conclusions: In this largest retrospective comparison of this population to date, women using the insulin pump in pregnancy had better glycemic control without an increased risk of severe hypoglycemia or diabetic ketoacidosis.

Nothing to Disclose: MK, JMK, JK, SB, AL, KL, QD, LED

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: Stewart Diabetes Fund; BC Endocrine Research Foundation
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