Optimizing insulin therapy in pregnant women with type 1 diabetes mellitus.
Optimizing insulin therapy in pregnant women with type 1 diabetes mellitus.
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DOI：
10.2165/00024677-200201040-00005
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发表时间：
2002-01-01
期刊：
影响因子：
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通讯作者：
Garg, Satish K
中科院分区：
文献类型：
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作者：
Gottlieb, Peter A;Frias, Juan P;Garg, Satish K
妊娠合并1型糖尿病与母婴并发症风险增加有关。怀孕前和怀孕期间正常或接近正常的血糖控制可将其中许多风险降低到在普通人群中观察到的水平。这种程度的血糖控制通常只有通过强化胰岛素治疗才能实现：每日多次注射(MDI)或通过胰岛素泵持续皮下注射胰岛素(CSII)。尽管CSII在患者生活方式方面提供了更大的灵活性，并可能减少低血糖的发生率，但这些治疗方案已被发现能够达到类似的血糖控制效果。为了优化血糖控制和降低低血糖的风险，在怀孕期间经常进行家庭血糖监测是非常必要的。此外，胰岛素需求量在怀孕期间会发生显著变化。新的短效胰岛素类似物，赖斯普罗胰岛素和天冬氨酸胰岛素，具有药效学特性，使它们成为怀孕期间使用的理想药物。尽管已发表的评估怀孕期间使用赖斯普罗胰岛素的研究数量有限，但大多数支持其安全性。目前还没有关于妊娠期胰岛素合成的研究全文发表。除了优化血糖控制外，在妊娠期经常评估微血管并发症的发展和/或进展是必要的。
Pregnancy complicated by type 1 diabetes mellitus is associated with an increased risk of complications in the mother and infant. Normal or near normal glycemic control prior to and during pregnancy reduces many of these risks to levels observed in the general population. This degree of glycemic control is generally achievable only with intensive insulin therapy: multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) via an insulin pump. These therapeutic regimens have been found to result in comparable glycemic control, although CSII provides increased flexibility in terms of patient lifestyle, and may reduce the incidence of hypoglycemia. Frequent home blood glucose monitoring is imperative during pregnancy in order to optimize glycemic control and reduce the risk of hypoglycemia. Furthermore, insulin requirements change significantly over the course of pregnancy. The new short-acting insulin analogs, insulin lispro and insulin aspart, have pharmacodynamic properties which make them ideal for use during pregnancy. Although the number of published studies evaluating the use of insulin lispro during pregnancy is limited, the majority support its safety. No studies of insulin aspart in pregnancy have been published in full. In addition to optimization of glycemic control, frequent assessment for development and/or progression of microvascular complications is necessary during pregnancy.