The incidence of severe hypoglycaemia in pregnant women with type 1 diabetes mellitus can be reduced with unchanged HbA1c levels and pregnancy outcomes in a routine care setting
The incidence of severe hypoglycaemia in pregnant women with type 1 diabetes mellitus can be reduced with unchanged HbA1c levels and pregnancy outcomes in a routine care setting
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DOI：
10.1016/j.diabres.2013.06.002
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发表时间：
2013-08-01
影响因子：
5.1
通讯作者：
Mathiesen, E. R.
中科院分区：
文献类型：
--
作者：
Ringholm, Lene;Secher, A. L.;Mathiesen, E. R.
目的：为了研究在不恶化HbA 1c水平或妊娠结局的情况下，在常规护理setting.Methods中是否可以降低1型糖尿病孕妇严重低血糖的发生率：比较两个队列（2004-2006; n = 108和2009-2011; n = 104）。在队列之间，实施了重点干预，包括对护理人员和患者进行预防低血糖的教育。女性在中位8周（范围5-13周）时入选。严重的低血糖（需要他人的帮助）是前瞻性的结构化interviews.Results报告：在第一与第二队列，严重的低血糖在怀孕期间发生在45%与23%，p = 0.0006，相应的发病率为2.5与1.6事件/患者年，p = 0.04。24%的事件发生意识丧失和/或惊厥，8%的事件发生意识丧失和/或惊厥。胰高血糖素和/或葡萄糖注射的发生率分别为15%和5%。入选时，两个队列之间的HbA 1c相当，而在第二个队列中，报告低血糖意识受损的女性较少（56% vs. 36%，p = 0.0006），每日多次注射的女性胰岛素剂量较低（0.77 IU/kg（0.4-1.7）vs. 0.65（0.2-1.4），p = 0.0006），更多的女性使用胰岛素类似物（速效44%对97%，p < 0.0001;长效6%对76%，p < 0.0001）和胰岛素泵（5%对23%，p < 0.0001）。妊娠结局相似，在两个cohols.Conclusions：一个36%的降低发生率的严重低血糖在妊娠期与不变的HbA 1c水平和妊娠结局后，观察到实施针对严重低血糖在常规护理设置的重点干预。改善胰岛素治疗，增加卫生专业教育和减少低血糖意识受损的妇女可能会有所贡献。(C)2013爱思唯尔爱尔兰有限公司版权所有。
Aims: To investigate whether the incidence of severe hypoglycaemia in pregnant women with type 1 diabetes can be reduced without deteriorating HbA1c levels or pregnancy outcomes in a routine care setting.Methods: Two cohorts (2004-2006; n = 108 and 2009-2011; n = 104) were compared. In between the cohorts a focused intervention including education of caregivers and patients in preventing hypoglycaemia was implemented. Women were included at median 8 (range 5-13) weeks. Severe hypoglycaemia (requiring assistance from others) was prospectively reported in structured interviews.Results: In the first vs. second cohort, severe hypoglycaemia during pregnancy occurred in 45% vs. 23%, p = 0.0006, corresponding to incidences of 2.5 vs. 1.6 events/patient-year, p = 0.04. Unconsciousness and/or convulsions occurred at 24% vs. 8% of events. Glucagon and/or glucose injections were given at 15% vs. 5% of events. At inclusion HbA1c was comparable between the cohorts while in the second cohort fewer women reported impaired hypoglycaemia awareness (56% vs. 36%, p = 0.0006), insulin dose in women on multiple daily injections was lower (0.77 IU/kg (0.4-1.7) vs. 0.65 (0.2-1.4), p = 0.0006) and more women were on insulin analogues (rapid-acting 44% vs. 97%, p < 0.0001; long-acting 6% vs. 76%, p < 0.0001) and insulin pumps (5% vs. 23%, p < 0.0001). Pregnancy outcomes were similar in the two cohorts.Conclusions: A 36% reduction in the incidence of severe hypoglycaemia in pregnancy with unchanged HbA1c levels and pregnancy outcomes was observed after implementation of focused intervention against severe hypoglycaemia in a routine care setting. Improved insulin treatment, increased health professional education and fewer women with impaired hypoglycaemia awareness may contribute. (C) 2013 Elsevier Ireland Ltd. All rights reserved.