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Insulin pump use in pregnancy is associated with lower HbA1c without increasing the rate of severe hypoglycaemia or diabetic ketoacidosis in women with type 1 diabetes

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Abstract

Aims/hypothesis

The aim of this study was to compare glycaemic control and maternal–fetal outcomes in women with type 1 diabetes managed on insulin pumps compared with multiple daily injections of insulin (MDI).

Methods

In a retrospective study, glycaemic control and outcomes of 387 consecutive pregnancies in women with type 1 diabetes who attended specialised clinics at three centres 2006–2010 were assessed.

Results

Women using insulin pumps (129/387) were older and had a longer duration of diabetes, more retinopathy, smoked less in pregnancy, and had more preconception care (p < 0.01 for each). Among 113 pregnancies >20 weeks’ gestation in women on insulin pumps and 218 in women on MDI, there was a significant difference in HbA1c in the first trimester (mean HbA1c 6.90 ± 0.71% (52 ± 7.8 mmol/mol) vs 7.60 ± 1.38% (60 ± 15.1 mmol/mol), p < 0.001), which persisted until the third trimester (mean HbA1c 6.49 ± 0.52% (47 ± 5.7 mmol/mol) vs 6.81 ± 0.85% (51 ± 9.3 mmol/mol), p = 0.002). Rates of diabetic ketoacidosis were similar in women on insulin pumps vs MDI (1.8% vs 3.0%, p = 0.72). Despite lower HbA1c, women on insulin pumps did not have an increased incidence of severe hypoglycaemia (8.0% vs 7.6%, p = 0.90) or more weight gain (16.3 ± 8.7 vs 15.2 ± 6.2 kg, p = 0.18). More large-for-gestational-age infants in the pump group (55.0% vs 39.2%, p = 0.007) may have resulted from confounding by parity.

Conclusions/interpretation

In this large multicentre study, women using insulin pumps in pregnancy had lower HbA1c without increased risk of severe hypoglycaemia or diabetic ketoacidosis but no improvement in other pregnancy outcomes. This information can help inform care providers and patients about the glycaemic effectiveness and safety of insulin pumps in pregnancy.

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Abbreviations

MDI:

Multiple daily injections of insulin

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Acknowledgements

We are grateful to the Data Integration Measurement and Reporting department, the Alberta Perinatal Health Program, and Research Excellence and Support Team of Alberta Health Services (Alberta, Canada) for their contributions.

Funding

Our study was supported by funding from the Stewart Diabetes Fund (Alberta, Canada) and the British Columbia Endocrine Research Foundation (British Columbia, Canada).

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

MMK-K, JMK and LED conceived and designed the study. SB, AKL and KIL also contributed to the study design. MMK-K collected the data, obtained funding and wrote the manuscript. JMK, LED and JAK facilitated data acquisition at their respective sites. SB contributed to data collection. QMD performed the statistical analysis. LED, JMK, JAK, SB, KIL, QMD and AKL critically reviewed and provided comments on the manuscript. All authors approved the final version.

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Authors and Affiliations

  1. Department of Medicine, Division of Endocrinology and Metabolism, University of British Columbia, Vancouver, BC, Canada

    Melissa M. Kallas-Koeman, Jason M. Kong & Jennifer A. Klinke

  2. Department of Medicine, Division of Endocrinology and Metabolism, Richmond Road Diagnostic and Treatment Centre, University of Calgary, 1820 Richmond Road SW, Calgary, AB, Canada, T2T 5C7

    Sonia Butalia & Lois E. Donovan

  3. Department of Pediatrics, Division of Neonatology, University of Calgary, Calgary, AB, Canada

    Abhay K. Lodha

  4. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of British Columbia, Vancouver, BC, Canada

    Ken I. Lim

  5. Research Excellence and Support Team, Research and Analytics, Alberta Health Services, Calgary, AB, Canada

    Qiuli M. Duan

Authors
  1. Melissa M. Kallas-Koeman
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  2. Jason M. Kong
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  3. Jennifer A. Klinke
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  5. Abhay K. Lodha
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  6. Ken I. Lim
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  8. Lois E. Donovan
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Corresponding author

Correspondence to Lois E. Donovan.

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Kallas-Koeman, M.M., Kong, J.M., Klinke, J.A. et al. Insulin pump use in pregnancy is associated with lower HbA1c without increasing the rate of severe hypoglycaemia or diabetic ketoacidosis in women with type 1 diabetes. Diabetologia 57, 681–689 (2014). https://doi.org/10.1007/s00125-014-3163-6

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  • DOI: https://doi.org/10.1007/s00125-014-3163-6

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