Nebojsa Lalic, Serbia
Faculty of Medicine University of Belgrade Clinic for Endocrinology, Diabetes and Metabolic DiseasesModerator of 1 Session
Presenter of 1 Presentation
Insulin pump treatment and insulin sensitivity during pregnancy: gestational vs. pre-existing diabetes
Abstract
Background and Aims / Part 1
Optimal metabolic control is important for favorable pregnancy outcomes in gestational diabetes (GD), pre-existing type 1 (pT1D) or type 2 diabetes (pT2D).
Methods / Part 2
During pregnancy, the fetal and placental growth induces hyperinsulinemia and insulin resistance (IR). Women with pT1D are most insulin sensitive during early stages of pregnancy, making them prone to hypoglycaemia. After 16 weeks of gestation, IR and insulin requirement increase rapidly, requiring tight glucose monitoring. American Diabetes Assosiation suggested a very narrow range for glycemic targets in pregnancy. In that context, continuous glucose monitoring (CGM) should be prioritized over self glucose monitoring because of significant improvement of glycemic control and neonatal outcomes in GD, pT1D or pT2D.
Results / Part 3
The new consensus in CGM has recommended a target range of 3.5-7.8 mmoL/L and more than 16 hours time in range (TIR) for pT1D. However, there is a lack of evidence on CGM targets for GD or pT2D. Multiple-daily injections of insulin (MDI) and continuous subcutaneous insulin infusion (CSII) are both effective approaches in GD, pT1D or pT2D. Randomised trials did not show superiority of CSII over MDI on glycemic control suggesting CGM as beneficial tool to extend TIR. Previous studies showed improvement of glycemic control by CSII in GD and pT2D, epsecially obese, with higher insulin requirement suggesting increased IR. CSII augmented by CGM favours optimal metabolic control and positive neonatal outcomes.
Conclusions / Part 4
Closed-loop delivery systems may be promising in the management of diabetes in pregnancy, but glucose targets are not customizable and currently are too high for pregnancy.