Peripartum management of glycemia in women with type 1 diabetes

Achong, Naomi, Duncan, Emma L., McIntyre, H. David, & Callaway, Leonie (2014) Peripartum management of glycemia in women with type 1 diabetes. Diabetes Care, 37(2), pp. 364-371.

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Abstract

OBJECTIVE We aimed to 1) describe the peripartum management of type 1 diabetes at an Australian teaching hospital and 2) discuss factors influencing the apparent transient insulin independence postpartum.

RESEARCH DESIGN AND METHODS We conducted a retrospective review of women with type 1 diabetes delivering singleton pregnancies from 2005 to 2010. Information was collected regarding demographics, medical history, peripartum management and outcome, and breast-feeding. To detect a difference in time to first postpartum blood glucose level (BGL) >8 mmol/L between women with an early (<4 h) and late (>12 h) requirement for insulin postpartum, with a power of 80% and a type 1 error of 0.05, at least 24 patients were required.

RESULTS An intravenous insulin infusion was commenced in almost 95% of women. Univariate analysis showed that increased BMI at term, lower creatinine at term, longer duration from last dose of long- or intermediate-acting insulin, and discontinuation of an insulin infusion postpartum were associated with a shorter time to first requirement of insulin postpartum (P = 0.005, 0.026, 0.026, and <0.001, respectively). There was a correlation between higher doses of insulin commenced postpartum and number of out-of-range BGLs (r[36] = 0.358, P = 0.030) and hypoglycemia (r[36] = 0.434, P = 0.007). Almost 60% had at least one BGL <3.5 mmol/L between delivery and discharge.

CONCLUSIONS Changes in the pharmacodynamic profile of insulin may contribute to the transient insulin independence sometimes observed postpartum in type 1 diabetes. A dose of 50–60% of the prepregnancy insulin requirement resulted in the lowest rate of hypoglycemia and glucose excursions. These results require validation in a larger, prospective study.

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ID Code: 94204
Item Type: Journal Article
Refereed: Yes
Keywords: creatinine, insulin, long acting insulin, glucose blood level, article, Australia, body mass, continuous infusion, correlation analysis, creatinine blood level, delivery, drug withdrawal, female, human, hypoglycemia, insulin dependent diabetes mellitus, major clinical study, non insulin dependent diabetes mellitus, patient care, perinatal period, pregnancy, puerperium, retrospective study, risk assessment, risk factor, treatment duration, adult, aged, blood, Diabetes Mellitus, Type 1, metabolism, Pregnancy in Diabetics, prospective study, Blood Glucose, Humans, Peripartum Period, Prospective Studies, Retrospective Studies
DOI: 10.2337/dc13-1348
ISSN: 0149-5992
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2014 by the American Diabetes Association
Deposited On: 23 Mar 2016 02:41
Last Modified: 24 Mar 2016 03:30

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