title: Is there a difference in pregnancy and glycemic outcome in patients with type 1 diabetes on insulin pump with constant or intermittent glucose monitoring? A pilot study.
abstract: BACKGROUND
  The aim of the study is to describe glycemic and insulin outcomes by trimester and maternal and fetal outcome in patients with type 1 diabetes using an insulin pump with constant or intermittent continuous glucose monitoring (CGM).
  
  
  METHODS
  Twenty-five women with type 1 diabetes with newly diagnosed pregnancy were treated with insulin pump therapy (Medtronic 722, Medtronic Minimed, Northridge, CA) for at least 1 year. Insulin pump and CGM (Medtronic Paradigm Real-Time) were implemented at least 3 months before conception. Patients were randomized in two groups: constant CGM group, 12 patients on insulin pump with glucose sensor, 24 h/day; and intermittent CGM group, 13 patients on insulin pump with intermittent glucose sensor, 14 days/month. The following parameters were analyzed: glycosylated hemoglobin (HbA1c), mean blood glucose, insulin requirement (in IU/kg/day), weight gain, severe hypoglycemic events, diabetic ketoacidosis, macrosomia, cesarean section, and neonatal hypoglycemia.
  
  
  RESULTS
  Both groups achieved good glucose control during their pregnancies (P<0.05): 6.78±1.3% and 6.92±0.9% at the beginning of the study compared with 6.14±0.9% (constant CGM group) and 6.23±0.6% (intermittent CGM group) at the end of the study (last HbA1c before delivery). There was no significant decrease of HbA1c between the two groups. The constant CGM group had a significantly lower A1c in the first trimester compared with the intermittent CGM group. Maternal and fetal outcome did not show a significant difference between the two groups.
  
  
  CONCLUSIONS
  Insulin pump therapy together with constant or intermittent CGM can improve diabetes control and pregnancy outcome in type 1 diabetes. The quality of the glucose profile at conception was the important factor for pregnancy outcome.
authors.affiliation: University Clinic of Endocrinology, Diabetes and Metabolic Disorders, Medical Faculty, Skopje, Macedonia. goranp@endocrinology.org.mk
authors.forename: Goran
authors.initials: G
authors.lastname: Petrovski
authors.forename: Cedomir
authors.initials: C
authors.lastname: Dimitrovski
authors.forename: Milco
authors.initials: M
authors.lastname: Bogoev
authors.forename: Tatjana
authors.initials: T
authors.lastname: Milenkovic
authors.forename: Irfan
authors.initials: I
authors.lastname: Ahmeti
authors.forename: Iskra
authors.initials: I
authors.lastname: Bitovska
mesh_terms: D000328:Adult; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D002585:Cesarean Section / Q000706:statistics & numerical data; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D018670:Monitoring, Ambulatory; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000097:blood*; D012720:Severity of Illness Index
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human