Insulin treatment, insulin requirements and perinatal outcomes in a pregnancy cohort with type 1 diabetes

Abstract Background Intensive-insulin treatment (IIT) strategy for patients with type 1 diabetes mellitus (T1DM) has been associated with sedentary behaviour and the development of insulin resistance. Exercising patients with T1DM often utilize a conventional insulin treatment (CIT) strategy leading to increased insulin sensitivity through improved intramyocellular lipid (IMCL) content. It is unclear how these exercise-related metabolic adaptations in response to exercise training relate to individual fibre-type transitions, and whether these alterations are evident between different insulin strategies (CIT vs. IIT). Purpose: This study examined glycogen and fat content in skeletal muscle fibres of diabetic rats following exercise-training. Methods Male Sprague-Dawley rats were divided into four groups: Control-Sedentary, CIT- and IIT-treated diabetic sedentary, and CIT-exercised trained (aerobic/resistance; DARE). After 12 weeks, muscle-fibre lipids and glycogen were compared through immunohistochemical analysis. Results The primary findings were that both IIT and DARE led to significant increases in type I fibres when compared to CIT, while DARE led to significantly increased lipid content in type I fibres compared to IIT. Conclusions These findings indicate that alterations in lipid content with insulin treatment and DARE are primarily evident in type I fibres, suggesting that muscle lipotoxicity in type 1 diabetes is muscle fibre-type dependant.

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Pregnancy and delivery in a patient with a 40-year history of type 1 diabetes mellitus and antiphospholipid syndrome

Journal of obstetrics and women s diseases ◽

10.17816/jowd67693-99 ◽

2018 ◽

Vol 67 (6) ◽

pp. 93-99

Author(s):

Roman V. Kapustin ◽

Natalia V. Borovik ◽

Ekaterina V. Musina ◽

Olga N. Arzhanova ◽

Maria I. Yarmolinskaya ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Antiphospholipid Syndrome ◽

Perinatal Outcomes ◽

Increased Risk ◽

Pregnancy And Delivery ◽

Perinatal Center ◽

History Of

Type 1 diabetes mellitus is a condition associated with an increased risk of adverse perinatal outcomes such as spontaneous abortions, preterm birth, placental insufficiency, congenital malformations, and perinatal mortality. Diabetes mellitus combined with cardiovascular diseases in women during pregnancy often leads to hypertensive disorders and pre-eclampsia. The severity of the microvascular diabetic complications and frequency of hypoglycemic episodes, particularly in early pregnancy, are related to the risk of pre-eclampsia. We report the case of pregnancy and delivery of a live newborn in a 42-year-old woman with type 1 diabetes mellitus, pre-existing hypertension, heritable thrombophilia, and antiphospholipid syndrome. She had a 40-year history of type 1 diabetes mellitus with well-controlled diabetic nephropathy and retinopathy. The woman had been receiving continuous subcutaneous insulin therapy for the last five years, which allowed maintaining an appropriate glycemic control during pregnancy. Multidisciplinary supervision of course of pregnancy was carried out from the pre-gravidity stage until delivery and postpartum. In spite of the severe pre-eclampsia and preterm delivery by cesarean section at 36 weeks, she and newborn could avoid the intensive unit care and discharge from perinatal center without any complications.

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Maternal and child gluten intake and risk of type 1 diabetes: The Norwegian Mother and Child Cohort Study

10.1101/19001883 ◽

2019 ◽

Author(s):

Nicolai A Lund-Blix ◽

German Tapia ◽

Karl Mårild ◽

Anne Lise Brantsaeter ◽

Pål R Njølstad ◽

...

Keyword(s):

Type 1 Diabetes ◽

Cohort Study ◽

Confidence Interval ◽

Population Based ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Pregnancy Cohort ◽

Increased Risk ◽

Mother And Child

ABSTRACTOBJECTIVETo examine the association between maternal and child gluten intake and risk of type 1 diabetes in children.DESIGNPregnancy cohortSETTINGPopulation-based, nation-wide study in NorwayPARTICIPANTS86,306 children in The Norwegian Mother and Child Cohort Study born from 1999 through 2009, followed to April 15, 2018.MAIN OUTCOME MEASURESClinical type 1 diabetes, ascertained in a nation-wide childhood diabetes registry. Hazard ratios were estimated using Cox regression for the exposures maternal gluten intake up to week 22 of pregnancy and child’s gluten intake when the child was 18 months old.RESULTSDuring a mean follow-up of 12.3 years (range 0.7-16.0), 346 children (0.4%) developed type 1 diabetes (incidence rate 32.6 per 100,000 person-years). The average gluten intake was 13.6 grams/day for mothers during pregnancy, and 8.8 grams/day for the child at 18 months of age. Maternal gluten intake in mid-pregnancy was not associated with the development of type 1 diabetes in the child (adjusted hazard ratio 1.02 (95% confidence interval 0.73 to 1.43) per 10 grams/day increase in gluten intake). However, the child’s gluten intake at 18 months of age was associated with an increased risk of later developing type 1 diabetes (adjusted hazard ratio 1.46 (95% confidence interval 1.06 to 2.01) per 10 grams/day increase in gluten intake).CONCLUSIONSThis study suggests that the child’s gluten intake at 18 months of age, and not the maternal intake during pregnancy, could increase the risk of type 1 diabetes in the child.WHAT IS ALREADY KNOWN ON THIS TOPICA national prospective cohort study from Denmark found that a high maternal gluten intake during pregnancy could increase the risk of type 1 diabetes in the offspring (adjusted hazard ratio 1.31 (95% confidence interval 1.001 to 1.72) per 10 grams/day increase in gluten intake). No studies have investigated the relation between the amount of gluten intake by both the mother during pregnancy and the child in early life and risk of developing type 1 diabetes in childhood.WHAT THIS STUDY ADDSIn this prospective population-based pregnancy cohort with 86,306 children of whom 346 developed type 1 diabetes we found that the child’s gluten intake at 18 months of age was associated with the risk of type 1 diabetes (adjusted hazard ratio 1.46 (95% confidence interval 1.06 to 2.01) per 10 grams/day increase in gluten intake). This study suggests that the child’s gluten intake at 18 months of age, and not the maternal intake during pregnancy, could increase the child’s risk of type 1 diabetes.

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Automated Adaptation of Insulin Treatment in Type 1 Diabetes

10.1109/embc46164.2021.9630191 ◽

2021 ◽

Author(s):

Chiara Fabris ◽

Thibault Gautier ◽

Marc Breton

Keyword(s):

Type 1 Diabetes ◽

Insulin Treatment

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Disturbed eating, illness perceptions, and coping among adults with type 1 diabetes on intensified insulin treatment, and their associations with metabolic control

Journal of Health Psychology ◽

10.1177/1359105319840688 ◽

2019 ◽

pp. 135910531984068 ◽

Cited By ~ 2

Author(s):

Line Wisting ◽

Astrid Rø ◽

Torild Skrivarhaug ◽

Knut Dahl-Jørgensen ◽

Øyvind Rø

Keyword(s):

Type 1 Diabetes ◽

Metabolic Control ◽

Insulin Treatment ◽

Illness Perceptions ◽

Disturbed Eating ◽

Intensified Insulin Treatment ◽

And Coping

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Earlier intensified insulin treatment of Type 1 diabetes and its association with long-term macrovascular and renal complications

Diabetic Medicine ◽

10.1111/dme.12897 ◽

2015 ◽

Vol 33 (4) ◽

pp. 463-470 ◽

Cited By ~ 2

Author(s):

B. Rathsman ◽

M. Donner ◽

C. Ursing ◽

T. Nyström

Keyword(s):

Type 1 Diabetes ◽

Insulin Treatment ◽

Renal Complications ◽

Intensified Insulin Treatment

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Insulin requirements throughout pregnancy in women with type 1 diabetes mellitus: three changes of direction

Diabetologia ◽

10.1007/s00125-009-1633-z ◽

2009 ◽

Vol 53 (3) ◽

pp. 446-451 ◽

Cited By ~ 81

Author(s):

A. García-Patterson ◽

I. Gich ◽

S. B. Amini ◽

P. M. Catalano ◽

A. de Leiva ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Insulin Requirements

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Factors determining insulin requirements in women with type 1 diabetes mellitus during pregnancy: a review

Obstetric Medicine ◽

10.1177/1753495x13516442 ◽

2014 ◽

Vol 7 (2) ◽

pp. 52-59 ◽

Cited By ~ 1

Author(s):

Naomi Achong ◽

Harold David McIntyre ◽

Leonie Callaway

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Cell Function ◽

Normal Pregnancy ◽

Late Gestation ◽

Premature Delivery ◽

Insulin Requirements ◽

In Pregnancy

Most women with type 1 diabetes mellitus (T1DM) have increased insulin requirements during pregnancy. However, a minority of women have a fall in insulin requirements. When this occurs in late gestation, it often provokes concern regarding possible compromise of the feto-placental unit. In some centres, this is considered as an indication for delivery, including premature delivery. There are, however, many other factors that affect insulin requirements in pregnancy in women with type 1 diabetes mellitus and the decline in insulin requirements may represent a variant of normal pregnancy. If there is no underlying pathological process, expedited delivery in these women is not warranted and confers increased risks to the newborn. We will explore the factors affecting insulin requirements in gestation in this review. We will also discuss some novel concepts regarding beta-cell function in pregnancy.

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