scholarly journals Evaluation of glycaemic profile variability as a basis for insulin therapy strategy in pregnant women with type 1 diabetes

2020 ◽  
Vol 22 (6) ◽  
pp. 526-535
Author(s):  
Alena V. Tiselko ◽  
Maria I. Yarmolinskaya ◽  
Elena V. Misharina ◽  
Yuliya P. Milyutina
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Pregnant Women ◽  
Glucose Monitoring ◽  
Glucose Variability ◽  
Neonatal Hypoglycaemia ◽  
Perinatal Complications ◽  
Therapy Strategy ◽  
Target Blood Glucose

BACKGROUND: Patients with any form of diabetes during pregnancy should achieve the target (close to physiological) values of glycaemia, the main condition for a safe course and outcomes of pregnancy. To accomplish this task, effective and safe methods of insulin therapy should be selected. AIM: To determine the glycaemic profile and pregnancy outcomes in women with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) and multiple insulin injections (MII). METHODS: A continuous glucose monitoring (CGM) of 100 pregnant women with type 1 diabetes treated with CSII and 100 women treated with MII was conducted to assess the effectiveness of these insulin therapy regimens in achieving target blood glucose values. RESULTS: HbA1c levels were significantly lower during the first, second, and third trimesters in patients treated with CSII than those treated with MII. Glucose variability has already improved since the second trimester of pregnancy in women treated with CSII, which was not observed in those treated with MII. The period of hyperglycaemia according to the results in pregnant women treated with CSII was 25 [13; 38] %, which was lower than those treated with MII, 41 [18; 54] %. No risk of obstetric and perinatal complications was observed with the duration of the hyperglycaemic state of 25% of the CGM time, whereas the risk of neonatal hypoglycaemia appeared with the duration of the hypoglycaemic state of a mother with type 1 diabetes of 0.2%. The relationship between glucose variability in terms of MAGE and MODD and the risk of developing macrosomia has been observed, and the dependence of glucose variability (MODD and CONGA) and the risk of neonatal hypoglycaemia and preeclampsia have also been confirmed. CONCLUSION: Comprehensive assessment of the glycaemic profile when using CSII, confirmed the advantages of using CSII in pregnant women with type 1 diabetes to achieve the target glycaemia values, to reduce glucose variability and duration of hypoglycaemic episodes, which led to decreased frequency of obstetric and perinatal complications.

scholarly journals Glucose Fluctuations during Gestation: An Additional Tool for Monitoring Pregnancy Complicated by Diabetes

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
M. G. Dalfrà ◽  
N. C. Chilelli ◽  
G. Di Cianni ◽  
G. Mello ◽  
C. Lencioni ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Pregnant Women ◽  
Glycemic Index ◽  
Glucose Monitoring ◽  
Mean Amplitude ◽  
Glucose Variability ◽  
Healthy Controls ◽  
Additional Tool ◽  
Glucose Fluctuations

Continuous glucose monitoring (CGM) gives a unique insight into magnitude and duration of daily glucose fluctuations. Limited data are available on glucose variability (GV) in pregnancy. We aimed to assess GV in healthy pregnant women and cases of type 1 diabetes mellitus or gestational diabetes (GDM) and its possible association with HbA1c. CGM was performed in 50 pregnant women (20 type 1, 20 GDM, and 10 healthy controls) in all three trimesters of pregnancy. We calculated mean amplitude of glycemic excursions (MAGE), standard deviation (SD), interquartile range (IQR), and continuous overlapping net glycemic action (CONGA), as parameters of GV. The high blood glycemic index (HBGI) and low blood glycemic index (LBGI) were also measured as indicators of hyperhypoglycemic risk. Women with type 1 diabetes showed higher GV, with a 2-fold higher risk of hyperglycemic spikes during the day, than healthy pregnant women or GDM ones. GDM women had only slightly higher GV parameters than healthy controls. HbA1c did not correlate with GV indicators in type 1 diabetes or GDM pregnancies. We provided new evidence of the importance of certain GV indicators in pregnant women with GDM or type 1 diabetes and recommended the use of CGM specifically in these populations.

scholarly journals Anxiety, depression, and glycemic control during Covid-19 pandemic in youths with type 1 diabetes

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Maria Cusinato ◽  
Mariangela Martino ◽  
Alex Sartori ◽  
Claudia Gabrielli ◽  
Laura Tassara ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Psychological Impact ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Well Being ◽  
Glucose Variability ◽  
Threshold Score ◽  
The Impact

Abstract Objectives Our study aims to assess the impact of lockdown during the coronavirus disease 2019 pandemic on glycemic control and psychological well-being in youths with type 1 diabetes. Methods We compared glycemic metrics during lockdown with the same period of 2019. The psychological impact was evaluated with the Test of Anxiety and Depression. Results We analyzed metrics of 117 adolescents (87% on Multiple Daily Injections and 100% were flash glucose monitoring/continuous glucose monitoring users). During the lockdown, we observed an increase of the percentage of time in range (TIR) (p<0.001), with a significant reduction of time in moderate (p=0.002), and severe hypoglycemia (p=0.001), as well as the percentage of time in hyperglycemia (p<0.001). Glucose variability did not differ (p=0.863). The glucose management indicator was lower (p=0.001). 7% of youths reached the threshold-score (≥115) for anxiety and 16% for depression. A higher score was associated with lower TIR [p=0.028, p=0.012]. Conclusions Glycemic control improved during the first lockdown period with respect to the previous year. Symptoms of depression and anxiety were associated with worse glycemic control; future researches are necessary to establish if this improvement is transient and if psychological difficulties will increase during the prolonged pandemic situation.

scholarly journals The UVA/Padova Type 1 Diabetes Simulator Goes From Single Meal to Single Day

2018 ◽  
Vol 12 (2) ◽  
pp. 273-281 ◽  
Author(s):  
Roberto Visentin ◽  
Enrique Campos-Náñez ◽  
Michele Schiavon ◽  
Dayu Lv ◽  
Martina Vettoretti ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
In Silico ◽  
Artificial Pancreas ◽  
Real Life ◽  
Glucose Monitoring ◽  
Glucose Variability ◽  
Self Monitoring ◽  
Inhaled Insulin ◽  
Single Meal

Background: A new version of the UVA/Padova Type 1 Diabetes (T1D) Simulator is presented which provides a more realistic testing scenario. The upgrades to the previous simulator, which was accepted by the Food and Drug Administration in 2013, are described. Method: Intraday variability of insulin sensitivity (SI) has been modeled, based on clinical T1D data, accounting for both intra- and intersubject variability of daily SI. Thus, time-varying distributions of both subject’s basal insulin infusion and insulin-to-carbohydrate ratio were calculated and made available to the user. A model of “dawn” phenomenon based on clinical T1D data has been also included. Moreover, the model of subcutaneous insulin delivery has been updated with a recently developed model of commercially available fast-acting insulin analogs. Models of both intradermal and inhaled insulin pharmacokinetics have been included. Finally, new models of error affecting continuous glucose monitoring and self-monitoring of blood glucose devices have been added. Results: One hundred in silico adults, adolescent, and children have been generated according to the above modifications. The new simulator reproduces the intraday glucose variability observed in clinical data, also describing the nocturnal glucose increase, and the simulated insulin profiles reflect real life data. Conclusions: The new modifications introduced in the T1D simulator allow to extend its domain of validity from “single-meal” to “single-day” scenarios, thus enabling a more realistic framework for in silico testing of advanced diabetes technologies including glucose sensors, new insulin molecules and artificial pancreas.

scholarly journals Continuous glucose monitoring use and glucose variability in pre-school children with type 1 diabetes

2019 ◽  
Vol 147 ◽  
pp. 76-80 ◽  
Author(s):  
Klemen Dovc ◽  
Kevin Cargnelutti ◽  
Anze Sturm ◽  
Julij Selb ◽  
Natasa Bratina ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Continuous Glucose Monitoring ◽  
School Children ◽  
Glucose Monitoring ◽  
Glucose Variability

scholarly journals Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies

Diabetologia ◽  
2019 ◽  
Vol 62 (7) ◽  
pp. 1143-1153 ◽  
Author(s):  
Karl Kristensen ◽  
Linda E. Ögge ◽  
Verena Sengpiel ◽  
Karin Kjölhede ◽  
Annika Dotevall ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Cohort Study ◽  
Pregnant Women ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Observational Cohort Study ◽  
Observational Cohort

scholarly journals Professional Continuous Glucose Monitoring for the Identification of Type 1 Diabetes Mellitus Among Subjects With Insulin Therapy

Medicine ◽  
2015 ◽  
Vol 94 (3) ◽  
pp. e421 ◽  
Author(s):  
Yin-Chun Chen ◽  
Yu-Yao Huang ◽  
Hung-Yuan Li ◽  
Shih-Wei Liu ◽  
Sheng-Hwu Hsieh ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Type 1 Diabetes Mellitus ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring
Sign in / Sign up

Export Citation Format

Share Document