Should the same glucose values be targeted for type 1 as for type 2 diabetics in pregnancy?
OBJECTIVE
Our purpose was to determine whether the same maternal glycemic control is necessary to achieve similar perinatal outcomes for type 1 as for type 2 diabetics.


METHODS
The subjects were all women with pregestational diabetes mellitus delivered of live-born singletons. Glycemic control was achieved with diet and insulin. Self-monitoring of blood glucose was performed before meals and at bedtime. Target glucose values were 60 to 90 mg/dl fasting and 60 to 105 mg/dl at other times.


RESULTS
Of 60,628 deliveries, 46 type 1 and 113 type 2 diabetic women met inclusion criteria. Respective differences were found between type 1 and type 2 diabetics in average daily glucose levels (112 mg/dl vs 97 mg/dl, p < 0.001), percent of values within target ranges (35% vs 57%, p < 0.001), and mean amplitude of glycemic excursion (48.1 mg/dl vs 24.9 mg/dl, p < 0.001). At least one daily glucose value was < 50 mg/dl during 19% of observation days for type 1 vs 2% of observation days for type 2 pregnancies (p < 0.001). There were no statistically significant differences between type 1 and type 2 diabetic pregnancies in neonatal macrosomia (30% vs 34%), proportion of cesarean deliveries during labor for arrest disorders (67% vs 69%), shoulder dystocia (2% vs 6%), and neonatal hypoglycemia (18% vs 26%).


CONCLUSIONS
Less stringent maternal glycemic control may permit comparable maternal and neonatal outcomes for type 1 compared with type 2 diabetics. Higher target values for type 1 diabetics may decrease the frequency of maternal hypoglycemic episodes.
Sacks
D A
DA
Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, Bellflower, CA 90706, USA.
Chen
W
W
Greenspoon
J S
JS
Wolde-Tsadik
G
G
D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood* / Q000628:therapy
D001786:Blood Glucose