Prof. Zhuravlyova LV, Rogachova TA Kharkiv National Medical University.

Until recently, pregnancy in type 1 diabetes mellitus caused high risk of complications for the mother and severe congenital abnormalities for the child. The main problems of pregnant women with diabetes were difficulties in achieving stable normal blood glucose level, avoiding hypoglycemia and ketoacidosis. Control of DM-1 during pregnancy is significantly complicated by the addition of physiological insulin resistance. In connection with hormonal changes, the need for insulin and insulin sensitivity vary significantly during different periods of pregnancy. The degree of expression of these changes is individual. During the last 10 years, there has been significant progress in the level of knowledge about the patterns of the course of DM-1 in pregnancy, also in methods of blood glucose monitoring and insulin delivery. Synthetic insulin analogues were developed and introduced into practice. After carefully studying the latest scientific evidence based data, we reviewed the latest advances in the treatment of diabetes type 1 in pregnant women.

Key words: pregnancy, diabetes mellitus type 1, blood glucose monitoring, insulin pump, insulin analogues.

https://dx.doi.org/10.15407/internalmed2018.01.078

Zhuravleva LV, Rogacheva TA. [Features of insulin therapy in patients with type 1 diabetes mellitus during pregnancy]. Shidnoevr. z. vnutr. simejnoi med. 2018;1:78-84. Russian.

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1. Moore T, Griffing G. Diabetes Mellitus and Pregnancy. Diabetes. 2010;6(7).

2. Feldman A, Brown F. Management of type 1 diabetes mellitus in pregnancy. Curr. Diab. Rep. 2016;16:76–78. doi: 10.1007/s11892-016-0765-z. https://doi.org/10.1007/s11892-016-0765-z

3. Bryant S, Herrera C, Nelson D, Cunningham F. Diabetic ketoacidosis complicating pregnancy. Journal of Neonatal-Perinatal Medicine. 2017; 10(1):17-23. doi: 10.3233/NPM-1663. https://doi.org/10.3233/NPM-1663

4. HolmesVA, Young IS, Patterson CC, Pearson DW, Walker JD, Maresh MJ, McCance DR; Diabetes and Pre-eclampsia Intervention Trial Study Group. Optimal glycemic control, pre-eclampsia, and gestational hypertension in women with type 1 diabetes in the diabetes and pre-eclampsia intervention trial. Diabetes Care. 2011 Aug;34(8):1683-8. doi: 10.2337/dc11-0244. Epub 2011 Jun 2. https://doi.org/10.2337/dc11-0244

5. Mathiesen ER. Pregnancy Outcomes in Women With Diabetes-Lessons Learned From Clinical Research: The 2015 Norbert Freinkel Award Lecture. Diabetes Care. 2016 Dec;39(12):2111-2117. DOI:10.2337/dc16-1647 https://doi.org/10.2337/dc16-1647

6. American Diabetes Association. Standards of medical care in diabetes—2016. Diabetes Care. 2016;39(1):1-106.

7. Barss V, Repke J. Patient education: Care during pregnancy for women with type 1 or 2 diabetes mellitus (Beyond the Basics). Available from https://www.uptodate.com/contents/care-during-pregnancy-for-women-with-type-1-or-2-diabetes-mellitus-beyond-the-basics

8. Ringholm L, Pedersen-Bjergaard U, Thorsteinsson B, et al. Hypoglycemia in pregnant women with type 1 diabetes: clinical features and management. Diabet Hypoglycemia. 2011;3:3–7.

9. Lapolla A, Dalfrà MG, Romoli E, Bonomo M, Moghetti P. Use of Insulin Lispro Protamine Suspension in Pregnancy. Adv Ther. 2015 Oct;32(10):888-905. doi: 10.1007/s12325-015-0244-y. Epub 2015 Oct 26. PMID: 26499176 PMCID: PMC4635182 https://doi.org/10.1007/s12325-015-0244-y

10. Jong J, Garne E, Wender-Ozegowska E, Morgan M, de Jong-van den Berg LT, Wang H. Insulin analogues in pregnancy and specific congenital anomalies: a literature review. Diabetes Metab Res Rev. 2016 May;32(4):366-75. doi: 10.1002/dmrr.2730. Epub 2015 Nov 6. PMID: 26431249 https://doi.org/10.1002/dmrr.2730

11. Mathiesen ER, Andersen H, Kring SI, Damm P. Design and rationale of a large, international, prospective cohort study to evaluate the occurrence of malformations and perinatal/neonatal death using insulin detemir in pregnant women with diabetes in comparison with other long-acting insulins. BMC Pregnancy Childbirth. 2017 Jan 18;17(1):38. doi: 10.1186/s12884-016-1177-4. PMID: 28100192 PMCID: PMC5241954 https://doi.org/10.1186/s12884-016-1177-4

12. Chico A, Herranz L, Corcoy R, Ramírez O, Goya MM, Bellart J, González-Romero S, Codina M, Sánchez P, Cortázar A, Acosta D, Picón MJ, Rubio JA, Megía A, Sancho MA, Balsells M, Solá E, González NL, López-López J; GEDE (Group of Diabetes and Pregnancy of the Spanish Diabetes Association). Glycemic control and maternal and fetal outcomes in pregnant women with type 1 diabetes according to the type of basal insulin. Eur J Obstet Gynecol Reprod Biol. 2016 Nov;206:84-91. 10.1016/j.ejogrb.2016.07.490. Epub 2016 Sep 9. PMID: 27639606 https://doi.org/10.1016/j.ejogrb.2016.07.490

13. Rezai S, Yuen S, Lam J, Hastings A, Mercado R, Henderson C (2015) Systematic Literature Review of Basal Bolus Insulin Analogue Therapy during Pregnancy. Obstet Gynecol Int J 3(2): 00079. DOI:10.15406/ogij.2015.03.00079 https://doi.org/10.15406/ogij.2015.03.00079

14. Lv S, Wang J, Xu Y. Safety of insulin analogs during pregnancy: a meta-analysis. Arch Gynecol Obstet. 2015 Oct;292(4):749-56. doi: 10.1007/s00404-015-3692-3. Epub 2015 Apr 9. PMID: 25855052 https://doi.org/10.1007/s00404-015-3692-3

15. Jamie Klein J, Charach R, Eyal Sheiner E. Treating diabetes during pregnancy. Expert Opinion on Pharmacotherapy. 2015;16(3):357-68. PMid:25424352

16. Diane Farrar D, Tuffnell D, West J, West H. Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes. The Cochrane Library. 2016.

17. Dalfrà MG, Soldato A, Moghetti P, Lombardi S, Vinci C, De Cata AP, Romanelli T, Bonomo M, Sciacca L, Tata F, Ragazzi E, Filippi A, Burlina S, Lapolla A. Diabetic pregnancy outcomes in mothers treated with basal insulin lispro protamine suspension or NPH insulin: a multicenter retrospective Italian study. J Matern Fetal Neonatal Med. 2016;29(7):1061-5. doi: 10.3109/14767058.2015.1033619. Epub 2015 Apr 21. PMID: 25817082 https://doi.org/10.3109/14767058.2015.1033619

18. Nielsen LR, Rehfeld JF, Pedersen-Bjergaard U, Damm P, Mathiesen ER. Pregnancy-induced rise in serum C-peptide concentrations in women with type 1 diabetes. Pregnancy-induced rise in serum C-peptide concentrations in women with type 1 diabetes. Diabetes Care. 2009 Jun;32(6):1052-7. doi: 10.2337/dc08-1832. Epub 2009 Feb 24. PMID: 19244092 PMCID: PMC2681014 https://doi.org/10.2337/dc08-1832

19. Sonagra AD, Biradar SM, K D, Murthy D S J. Normal pregnancy- a state of insulin resistance. J Clin Diagn Res. 2014 Nov;8(11):CC01-3. doi: 10.7860/JCDR/2014/10068.5081. Epub 2014 Nov 20. PMID: 25584208 PMCID: PMC4290225 https://doi.org/10.7860/JCDR/2014/10068.5081

20. Garg S, Moser E, Dain MP, Rodionova A. Clinical experience with insulin glargine in type 1 diabetes. Diabetes Technol Ther. 2010 Nov;12(11):835-46. doi: 10.1089/dia.2010.0135. Epub 2010 Oct 22. PMID: 20969435 PMCID: PMC2978054 https://doi.org/10.1089/dia.2010.0135

21. Heise T, Pieber TR. Towards peakless, reproducible and long-acting insulins. An assessment of the basal analogues based on isoglycaemic clamp studies. Diabetes Obes Metab. 2007 Sep;9(5):648-59. Epub 2007 Jul 21. PMID: 17645556 https://doi.org/10.1111/j.1463-1326.2007.00756.x PMid:17645556

22. Barbour LA, McCurdy CE, Hernandez TL, Kirwan JP, Catalano PM, Friedman JE. Cellular mechanisms for insulin resistance in normal pregnancy and gestational diabetes. Diabetes Care. 2007 Jul;30 Suppl 2:S112-9. PMID: 17596458 DOI: 10.2337/dc07-s202 https://doi.org/10.2337/dc07-s202

23. Mathiesen ER, Hod M, Ivanisevic M, Duran Garcia S, Brøndsted L, Jovanovic L, Damm P, McCance DR; Detemir in Pregnancy Study Group. Maternal efficacy and safety outcomes in a randomized, controlled trial comparing insulin detemir with NPH insulin in 310 pregnant women with type 1 diabetes. Diabetes Care. 2012 Oct;35(10):2012-7. Epub 2012 Jul 30. PMID: 22851598 PMCID: PMC3447831 https://doi.org/10.2337/dc11-2264 PMid:22851598 PMCid:PMC3447831

24. Hod M, Mathiesen ER, Jovanovič L, McCance DR, Ivanisevic M, Durán-Garcia S, Brøndsted L, Nazeri A, Damm P. A randomized trial comparing perinatal outcomes using insulin detemir or neutral protamine Hagedorn in type 1 diabetes. J Matern Fetal Neonatal Med. 2014 Jan;27(1):7-13. doi: 10.3109/14767058.2013.799650. Epub 2013 Jun 5. PMID: 23617228 PMCID: PMC3862070 https://doi.org/10.3109/14767058.2013.799650

25. Callesen NF, Ringholm L, Stage E, Damm P, Mathiesen ER. Insulin requirements in type 1 diabetic pregnancy: do twin pregnant women require twice as much insulin as singleton pregnant women? Diabetes Care. 2012 Jun;35(6):1246-8. doi: 10.2337/dc11-2467. Epub 2012 Mar 19. PMID: 22432115 PMCID: PMC3357219 https://doi.org/10.2337/dc11-2467

26. Feig DS, Donovan LE, Corcoy R, Murphy KE, Amiel SA, Hunt KF, Asztalos E, Barrett JFR, Sanchez JJ, de Leiva A, Hod M, Jovanovic L, Keely E, McManus R, Hutton EK, Meek CL, Stewart ZA, Wysocki T, O’Brien R, Ruedy K, Kollman C, Tomlinson G, Murphy HR; CONCEPTT Collaborative Group. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet. 2017 Nov 25;390(10110):2347-2359. doi: 10.1016/S0140-6736(17)32400-5. Epub 2017 Sep 15. PMID: 28923465 PMCID: PMC5713979 https://doi.org/10.1016/S0140-6736(17)32400-5

27. Secher AL, Stage E, Ringholm L, Barfred C, Damm P, Mathiesen ER. Real-time continuous glucose monitoring as a tool to prevent severe hypoglycaemia in selected pregnant women with Type 1 diabetes – an observational study. Diabet Med. 2014 Mar;31(3):352-6. doi: 10.1111/dme.12383. Epub 2014 Jan 28. PMID: 24341466 https://doi.org/10.1111/dme.12383

28. Stewart ZA, Wilinska ME, Hartnell S, Temple RC, Rayman G, Stanley KP, Simmons D, Law GR, Scott EM, Hovorka R, Murphy HR. Closed-Loop Insulin Delivery during Pregnancy in Women with Type 1 Diabetes. N Engl J Med. 2016 Aug 18;375(7):644-54. doi: 10.1056/NEJMoa1602494.PMID: 27532830

29. Sperling JD, Maggio L, Has P, Daley J, Coustan DR, Werner EF. Insulin Delivery Method and Admission for Glycemic Control in Pregnant Women with Type 1 Diabetes Mellitus. Am J Perinatol. 2018 Feb;35(3):209-214. doi: 10.1055/s-0037-1604196. Epub 2017 Jul 14. PMID: 28709165 https://doi.org/10.1055/s-0037-1604196

30. Golden SH, Sapir T. Methods for insulin delivery and glucose monitoring in diabetes: summary of a comparative effectiveness review. J Manag Care Pharm. 2012; 18(6 Suppl):S1-17. PMID:22984955 https://doi.org/10.18553/jmcp.2012.18.s6-A.1 PMid:22984955

31. Mello G, Biagioni S, Ottanelli S, Nardini C, Tredici Z, Serena C, Marchi L, Mecacci F. Continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) of rapid-acting insulin analogues and detemir in type 1 diabetic (T1D) pregnant women. J Matern Fetal Neonatal Med. 2015 Feb;28(3):276-80. doi: 10.3109/14767058.2014.914922. Epub 2014 May 22. PMID: 24724804 https://doi.org/10.3109/14767058.2014.914922

32. Kekäläinen P, Juuti M, Walle T, Laatikainen T. Continuous Subcutaneous Insulin Infusion During Pregnancy in Women with Complicated Type 1 Diabetes Is Associated with Better Glycemic Control but Not with Improvement in Pregnancy Outcomes. Diabetes Technol Ther. 2016 Mar;18(3):144-50. doi: 10.1089/dia.2015.0165. Epub 2015 Oct 26. PMID: 26502287 https://doi.org/10.1089/dia.2015.0165

33. Abell SK, Suen M, Pease A, Boyle JA, Soldatos G, Regan J, Wallace EM, Teede HJ. Pregnancy Outcomes and Insulin Requirements in Women with Type 1 Diabetes Treated with Continuous Subcutaneous Insulin Infusion and Multiple Daily Injections: Cohort Study. Diabetes Technol Ther. 2017 May;19(5):280-287. doi: 10.1089/dia.2016.0412. Epub 2017 Mar 10. PMID: 28282241 https://doi.org/10.1089/dia.2016.0412