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Multiple daily insulin injections during pregnancy may decrease adverse outcomes
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SAN DIEGO — Multiple daily insulin injections may be more effective than insulin pump use during pregnancy for lowering HbA1c and preventing adverse obstetric and neonatal outcomes, according to new data from the CONCEPTT trial.
“[Insulin] pumps are increasingly being used both before and during pregnancy, but there are no randomized controlled data comparing the modern pumps with multiple daily injection use,” Denice S. Feig, MD, MSc, FRCP, associate professor at the University of Toronto, said during a presentation. “The aim of this substudy was to compare maternal glycemic control and obstetric and neonatal outcomes in women with type 1 diabetes using pump and multiple daily injection therapy.”
Feig and colleagues evaluated data from the Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy (CONCEPTT) trial on pregnant women with type 1 diabetes using insulin pump therapy (n = 125; mean age, 32 years) or multiple daily injections (n = 123; mean age, 31 years).
At 16 weeks’ gestation, which the researchers identified as baseline, pump users had a longer duration of diabetes by nearly 2 years. However, diabetes complications and insulin dose were similar between the pump and multiple-injection groups.
At baseline, HbA1c was slightly lower in the pump group compared with the multiple daily injection group. More participants in the pump group had reached an HbA1c goal of under 6.5% compared with the multiple-injection group; however, this was not statistically significant.
At 24 weeks’ gestation, HbA1c decreased in both groups. More women in the multiple-injection group reached an HbA1c of 6.5% (n = 76) compared with the pump group (n = 54). Similarly, at 34 weeks, more participants in the multiple-injection group reached an HbA1c of 6.5% (n = 67) compared with the pump group (n = 54). From baseline to 34 weeks’ gestation, the decrease in HbA1c was 0.22% greater in the multiple-injection group compared with the pump group.
The researchers reported significant differences between the groups for time in target (3.5-7.8 mmol/L) or percent time above target (> 7.8 mmol/L). Both groups experienced declines in time spent hypoglycemic, but the pump group had significantly less time spent hypoglycemic. In the pump group, there was also a trend toward less glucose variability compared with the multiple-injection group.
More women in the pump group had hypertension (P < .01), gestational hypertension (P = .024), preterm delivery (P = .04 after adjustment for baseline differences) compared with the multiple-injection group. Further, more participants’ babies in the pump group required NICU care for more than 24 hours (P = .04) and experienced neonatal hypoglycemia (P = .04) compared with babies in the multiple-injection group.
“Pump users seem to start pregnancy with similar glycemic control as multiple daily injection users,” Feig said. “They had similar time in target and similar time above target. ... However, they had less of a decrease in HbA1c even when taking into account baseline differences including baseline HbA1c and [fewer] women reached their target of under 6.5%. ... Pump users had more gestational hypertension, more preterm births and NICU admissions over 24 hours and there was a trend toward more neonatal hypoglycemia. Overall, it looks like there are slightly worse outcomes in pump users, which is very surprising.” – by Amber Cox
Reference:
Feig DS. The CONCEPTT Trial — Continuous Glucose Monitoring in Women with Type 1 Diabetes. Presented at: American Diabetes Association 77th Scientific Sessions; June 9-13, 2017; San Diego.
Disclosures: Feig reports financial ties with AstraZeneca and Medtronic.