Different intensities of glycaemic control (tight versus very tight) for pregnant women with pre-existing diabetes

Background: The aim of the study was to compare the continuous glucose monitoring (CGM)-determined glycaemic variability (GV) of pregnant women with gestational diabetes mellitus (GDM) and without GDM (CG; control group). The secondary aim was to evaluate the association between risk factors of diabetes in pregnancy and parameters of glyceamic control. Methods: Demographic, biometric and biochemical parameters were obtained for pregnant women (20–38 years old) who after an oral glucose tolerance test were examined by 7-day continuous glucose monitoring using a iPro®2 Professional CGM. Results: The differences in GV between women with GDM and CG compared by total area under glucose curve (total AUC, (mmol·day/L) was statistically significant (p = 0.006). Other parameters of glycaemic control such as mean glucose, standard deviation, coefficient of variation, J-index, % time-above target range 7.8 mmol/L (%TAR), % time-in range 3.5–7.8 mmol/L (%TIR), time-below target range 3.5 mmol/L (%TBR), glycated haemoglobin were not significantly different in the study groups. Risk factors (a family history of diabetes, pre-pregnancy BMI, higher weight gain and age) correlated with parameters of glycaemic control. Conclusions: We found a significant difference in GV of women with and without GDM by total AUC determined from CGM. TIR metrics were close to significance. Our work points at an increased GV in relation to the risk factors of GDM. Pregnant women with risk factors have higher probability of severe GV with its consequences on maternal and fetal health state.

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Suggested Insulin Regimen for Pregnant Women with Diabetes Who Wish To Fast in Ramadan

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v17i2.990 ◽

2018 ◽

Vol 17 (2) ◽

Author(s):

Ahmad Shuib Yahaya ◽

Adibah Ibrahim ◽

Mohd Shukri Othman ◽

Mohd Pazudin Ismail

Keyword(s):

Blood Glucose ◽

Glycaemic Control ◽

Pregnant Women ◽

Insulin Requirement ◽

Hypoglycaemic Episode ◽

Total Daily Dose ◽

Insulin Regimen ◽

Ramadan Fasting ◽

Safety And Efficacy ◽

Acting Insulin

Introduction: Pregnant women are among those who are exempted from Ramadan fasting. Despite that, many pregnant women had chosen to fast despite understanding the risk of complications especially hypoglycaemia. In Hospital USM (HUSM), an insulin regime for pregnant women who wish to fast was designed based on expert opinion of obstetricians, but its safety and efficacy are yet to be determined. Objective: To determine the safety and efficacy of the formulated insulin regime using subcutaneous Actrapid® and Insulatard® amongst pregnant women with diabetes who fast in Ramadan. Methodology: Pregnant patients with diabetes on insulin who wish to fast during Ramadan were invited to participate in the study. The total daily dose of insulin requirement prior to Ramadan was divided 3 parts; 2/3 for iftar (sunset meal) and 1/3 for sahur (pre-dawn meal). For each timing, 2/3 of the calculated dose was given as short-acting insulin Actrapid® and remaining 1/3 as intermediate-acting insulin Insulatard®. Three patients were monitored in the ward while fasting for two days. Blood glucose checked eight times a day. Following that, eight patients were followed up during Ramadan fasting with this regime. Weekly blood sugar profile (BSP) was taken and glycaemic control evaluated. Results: All patients were able to fast without any hypoglycaemic episode, both during in-patient study and during out-patient Ramadan fasting. Mean daily blood glucose per day for in-patient monitoring was 7.3 mmol/l with the lowest being 4.56 mmol/l in the afternoon. During Ramadan fasting, average glucose level was higher (6.79 mmol/l) compared to prior to Ramadan value (5.67 mmol/l) (p> 0.05). However, improvement of glycaemic control was observed towards end of Ramadan. Conclusion: Pregnant women with diabetes treated with insulin can fast safely during Ramadan using the suggested insulin regime with improvement of glycaemic control observed at the end of Ramadan.

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Prevalence of Hypoglycaemia among Insulin-Treated Pregnant Women with Diabetes Who Achieved Tight Glycaemic Control

Journal of the ASEAN Federation of Endocrine Societies ◽

10.15605/jafes.034.01.06 ◽

2019 ◽

Vol 34 (1) ◽

pp. 29-35

Author(s):

Danish Ng ◽

◽

Nurain Mohd Noor ◽

Sy Liang Yong

Keyword(s):

Glycaemic Control ◽

Pregnant Women ◽

Tight Glycaemic Control

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Glycoregulation During Pregnancy

Serbian Journal of Experimental and Clinical Research ◽

10.1515/sjecr-2017-0009 ◽

2019 ◽

Vol 20 (2) ◽

pp. 9-16

Author(s):

Violeta Mladenovic ◽

Milica Dimitrijevic-Stojanovic ◽

Djuro Macut ◽

Aleksandar Djukic

Keyword(s):

Glycaemic Control ◽

Glucose Tolerance ◽

Pregnant Women ◽

Glucose Intolerance ◽

First Trimester ◽

Normal Glucose Tolerance ◽

Third Trimester ◽

Normal Glucose ◽

The Difference

Abstract Pregnancy is a period marked by profound changes in a woman’s hormonal status and metabolism, including the development of a carbohydrate-intolerant state. Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The aim of this study was to estimate and analyse the parameters of glycaemic control during pregnancy. We stratified patients into the following three groups according to OGTT results: normal glucose tolerance (NTG), gestational impaired glucose tolerance (GIGT) and GDM. We investigated 92 pregnant women, diagnosed with vital and desired pregnancy up to 12 weeks of gestation, who had signed informed consent forms. Among them, 7 pregnant women had a spontaneous abortion, while 8 pregnant women dropped out, so a total of 77 pregnant women completed the trial. Most of the women examined had no risk factors (48%), while 35% of the women had one risk factor. The current study demonstrates that normal glucose tolerance was shown in 59 (76.6%) participants, while some form of glucose intolerance (GIGT or GDM) was shown in 18 (23.4%) patients. Our findings revealed an increase in glucose intolerance with advancing pregnancy (in the second and third trimester). In conclusion, we demonstrate that the difference in the quality of glycaemic control during pregnancy is manifested in the second and third trimester, until it manifests in the first trimester. These findings underpin the clinical significance of discovering GDM.

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