The incidence of severe hypoglycaemia in pregnant women with type 1 diabetes mellitus can be reduced with unchanged HbA1c levels and pregnancy outcomes in a routine care setting

摘要

Aims: To investigate whether the incidence of severe hypoglycaemia in pregnant women with type 1 diabetes can be reduced without deteriorating HbA1c levels or pregnancy outcomes in a routine care setting. Methods: Two cohorts (2004-2006; n= 108 and 2009-2011; n= 104) were compared. In between the cohorts a focused intervention including education of caregivers and patients in preventing hypoglycaemia was implemented. Women were included at median 8 (range 5-13) weeks. Severe hypoglycaemia (requiring assistance from others) was prospectively reported in structured interviews. Results: In the first vs. second cohort, severe hypoglycaemia during pregnancy occurred in 45% vs. 23%, p= 0.0006, corresponding to incidences of 2.5 vs. 1.6 events/patient-year, p= 0.04. Unconsciousness and/or convulsions occurred at 24% vs. 8% of events. Glucagon and/or glucose injections were given at 15% vs. 5% of events. At inclusion HbA1c was comparable between the cohorts while in the second cohort fewer women reported impaired hypoglycaemia awareness (56% vs. 36%, p= 0.0006), insulin dose in women on multiple daily injections was lower (0.77. IU/kg (0.4-1.7) vs. 0.65 (0.2-1.4), p= 0.0006) and more women were on insulin analogues (rapid-acting 44% vs. 97%, p< 0.0001; long-acting 6% vs. 76%, p< 0.0001) and insulin pumps (5% vs. 23%, p< 0.0001). Pregnancy outcomes were similar in the two cohorts. Conclusions: A 36% reduction in the incidence of severe hypoglycaemia in pregnancy with unchanged HbA1c levels and pregnancy outcomes was observed after implementation of focused intervention against severe hypoglycaemia in a routine care setting. Improved insulin treatment, increased health professional education and fewer women with impaired hypoglycaemia awareness may contribute.