Peripartum management of glycemia in women with type 1 diabetes

Achong, Naomi, Duncan, Emma L., McIntyre, H. David and Callaway, Leonie (2014) Peripartum management of glycemia in women with type 1 diabetes. Diabetes Care, 37 2: 364-371. doi:10.2337/dc13-1348

Author Achong, Naomi
Duncan, Emma L.
McIntyre, H. David
Callaway, Leonie
Title Peripartum management of glycemia in women with type 1 diabetes
Journal name Diabetes Care   Check publisher's open access policy
ISSN 0149-5992
Publication date 2014-01-01
Year available 2014
Sub-type Article (original research)
DOI 10.2337/dc13-1348
Open Access Status
Volume 37
Issue 2
Start page 364
End page 371
Total pages 8
Place of publication Alexandria, VA United States
Publisher American Diabetes Association
Language eng
Subject 2724 Internal Medicine
2712 Endocrinology, Diabetes and Metabolism
2902 Advanced and Specialised Nursing
Abstract We aimed to 1) describe the peripartum management of type 1 diabetes at an Australian teaching hospital and 2) discuss factors influencing the apparent transient insulin independence postpartum. RESEARCH DESIGN AND METHODS We conducted a retrospective review of women with type 1 diabetes delivering singleton pregnancies from 2005 to 2010. Information was collected regarding demographics, medical history, peripartum management and outcome, and breast-feeding. To detect a difference in time to first postpartum blood glucose level (BGL) >8 mmol/L between women with an early (<4 h) and late (>12 h) requirement for insulin postpartum, with a power of 80% and a type 1 error of 0.05, at least 24 patients were required. RESULTS An intravenous insulin infusion was commenced in almost 95% of women. Univariate analysis showed that increased BMI at term, lower creatinine at term, longer duration from last dose of long- or intermediate-acting insulin, and discontinuation of an insulin infusion postpartum were associated with a shorter time to first requirement of insulin postpartum (P = 0.005, 0.026, 0.026, and <0.001, respectively). There was a correlation between higher doses of insulin commenced postpartum and number of out-of-range BGLs (r[36] = 0.358, P = 0.030) and hypoglycemia (r[36] = 0.434, P = 0.007). Almost 60% had at least one BGL <3.5 mmol/L between delivery and discharge. CONCLUSIONS Changes in the pharmacodynamic profile of insulin may contribute to the transient insulin independence sometimes observed postpartum in type 1 diabetes. A dose of 50-60% of the prepregnancy insulin requirement resulted in the lowest rate of hypoglycemia and glucose excursions. These results require validation in a larger, prospective study.
Keyword Endocrinology & Metabolism
Endocrinology & Metabolism
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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