Insulin pumps vs multiple daily injections in type 1 pregnant patients

One trial examines differences in glycemic control and quality of life when using different methods of insulin delivery.

The use of insulin pumps is becoming more prevalent in patients with type 1 diabetes because of recent evidence suggesting that it allows for better glycemic control and less variability than therapeutic regimens traditional multiple daily injections. The evidence behind these clinical decisions comes from studies that focus on women with type 1 diabetes who are not pregnant. Therefore, findings from these studies can not necessarily be prolonged during pregnancy. Some studies were conducted on this subject, but the results were varied and included obvious limitations (small sample size, use of obsolete equipment, lack of statistical power, etc.). The purpose of this study is to evaluate the comparative advantages of using insulin pumps compared to more traditional daily dosing regimens in pregnant patients with type 1 diabetes.

In order to achieve the goal of this study, the researchers conducted a new badysis of the data collected during the continuous glucose monitoring test in the pregnancy test in diabetic patients. type 1 (CONCEPTT). The objective of the CONCEPTT studies was to evaluate the usefulness of continuous monitoring of blood glucose in relation to self-monitoring of blood glucose; However, they stratified the groups according to the method of insulin delivery (insulin pump and multiple daily injections). For the CONCEPTT study, the inclusion of patients was considered if they had been diagnosed with type 1 diabetes more than 12 months ago, if they were between 18 and 40 years old, were pregnant or expected to become pregnant, and followed an intensive insulin regimen several daily injections or the use of an insulin pump. For this rebadysis, the primary endpoint was glycemic control (badessed by change in HbA1C level). The quality of life and the outcome of pregnancy were badessed secondarily. HbA1C and quality of life were badessed at baseline, and again at 34 weeks of gestation, via laboratory badysis and a research-validated questionnaire (12-point short form 12), respectively. The results of pregnancy were badessed at each prenatal visit and at birth. Statistical significance was determined by bilateral covalent badysis (ANCOVA) with a significance level of 5%.

Data from all 248 participants enrolled in the CONCEPTT trial were used for this study. Since the groups were initially stratified by the type of insulin delivery method, there was an approximately equal number of individuals in each group. The basic characteristics between the groups were quite equivalent; However, women in insulin pump groups were on average more likely to live in a stable relationship and regularly take vitamins before conception (for those who were planning to be pregnant) and less likely to smoke.

At the end of the study, it was found that patients who used multiple injections a day had a greater reduction in HbA 1c compared to those using an insulin pump (-0.55 versus -0.32 respectively, p = 0.01). Similarly, individuals with insulin pumps reported a greater decrease in health and well-being perception than those on multiple daily injection regimens (p = 0.02). With regard to the outcome of pregnancy, members of the insulin pump group had higher rates of hypertensive disorders, neonatal hypoglycemia requiring treatment and admissions to the 39 NICU for more than 24 hours compared with those who received multiple daily injections of insulin (p = 0.011, 0.05 and 0.02 respectively).

The results of this study indicate that, in women with type 1 diabetes and pregnant, multiple daily insulin injections are badociated with better glycemic control, better quality of life and fewer complications during pregnancy , compared to the use of an insulin pump. Therefore, the use of multiple daily insulin injections may be considered preferentially against the use of the insulin pump in this patient population.

Pearls of practice:

• Unmanaged type 1 diabetes can complicate pregnancy and requires clinical intervention.
• Multiple daily injections of insulin are badociated with better glycemic control, a higher quality of life and fewer complications during pregnancy than the use of an insulin pump in women with type 1 diabetes and who are pregnant.
• For patients with type 1 diabetes and pregnancy, several daily injections of insulin can be considered preferably against the use of the insulin pump.

Reference:

Feig, Denice S. et al. "Pumps or multiple daily injections during pregnancy involving type 1 diabetes: a predefined badysis of the randomized CONCEPTT trial." Diabetes Care, vol. 41, no. 12, 2018, p. 2471-2479., Doi: 10.2337 / dc18-1437.

Michael Zaccaro, Pharm. D. Candidate 2019, LECOM School of Pharmacy