title: Type 1 diabetes control and pregnancy outcomes in women treated with continuous subcutaneous insulin infusion (CSII) or with insulin glargine and multiple daily injections of rapid-acting insulin analogues (glargine-MDI).
abstract: OBJECTIVE
  The best way to treat pregnant patients who have type 1 diabetes is still unclear. For this reason, the present study compared metabolic control and maternal-fetal outcomes in patients treated with continuous subcutaneous infusions of rapid-acting insulin analogues (CSII) or with insulin glargine and multiple daily injections of rapid-acting insulin analogues (glargine-MDI).
  
  
  METHODS
  This retrospective multicentre study involved 144 women with type 1 diabetes, 100 of whom were using CSII and 44 glargine-MDI. Outcomes analyzed were metabolic control, diabetes complications, pregnancy outcome, perinatal morbidity and mortality, and fetal malformations.
  
  
  RESULTS
  The two groups were comparable for age, prepregnancy BMI, primiparous rate and diabetes complications, although patients using CSII had longer duration of diabetes (P=0.03) and higher White classifications (P=0.04). In both groups, metabolic control improved during pregnancy, but good control was reached earlier among patients using CSII. At parturition, patients using CSII had lower HbA(1c) (6.2±0.7% vs 6.5±0.8%; P=0.02) and required less insulin (P<0.01). Weight gain was similar in both groups, and maternal-fetal outcomes did not differ.
  
  
  CONCLUSIONS
  In pregnant patients with type 1 diabetes, MDI and CSII are equivalent in terms of metabolic control and fetal-maternal outcomes, although patients using CSII achieved good control earlier and with less insulin.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy. daniela.bruttomesso@unipd.it
authors.forename: D
authors.initials: D
authors.lastname: Bruttomesso
authors.forename: M
authors.initials: M
authors.lastname: Bonomo
authors.forename: S
authors.initials: S
authors.lastname: Costa
authors.forename: M
authors.initials: M
authors.lastname: Dal Pos
authors.forename: G
authors.initials: G
authors.lastname: Di Cianni
authors.forename: F
authors.initials: F
authors.lastname: Pellicano
authors.forename: E
authors.initials: E
authors.lastname: Vitacolonna
authors.forename: A R
authors.initials: AR
authors.lastname: Dodesini
authors.forename: L
authors.initials: L
authors.lastname: Tonutti
authors.forename: A
authors.initials: A
authors.lastname: Lapolla
authors.forename: A
authors.initials: A
authors.lastname: Di Benedetto
authors.forename: E
authors.initials: E
authors.lastname: Torlone
mesh_terms: D000328:Adult; D048909:Diabetes Complications / Q000401:mortality / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005315:Fetal Diseases / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007231:Infant, Newborn; D055104:Infusions, Subcutaneous; D000069036:Insulin Glargine; D007332:Insulin Infusion Systems; D049528:Insulin, Long-Acting / Q000008:administration & dosage*; D009017:Morbidity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies
chemical_list: D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine