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[IP] Insulin Pumps in Pregnancies Complicated by Type 2 Diabetes and Gestational Diab

Care -- Abstracts: Simmons et al. 24 (12): 2078</A>
Emerging Treatments and Technologies
Original Article

Use of Insulin Pumps in Pregnancies Complicated by Type 2 Diabetes and
Gestational Diabetes in a Multiethnic Community

David Simmons, FRACP, MD1, Colin F. Thompson, FRACP2, Caroline Conroy, RN3
and David J. Scott, FRACP, PHD3 1 Department of Rural Health, University of
Melbourne, Shepparton, Victoria, Australia
2 Diabetes Projects Trust, Middlemore Hospital, Otahuhu, Auckland, New
3 South Auckland Health, Otahuhu, Auckland, New Zealand OBJECTIVEbTo
the use of insulin pump therapy in women with gestational diabetes mellitus
(GDM) or type 2 diabetes in pregnancy and persistent hyperglycemia despite
multiple injections of subcutaneous insulin. RESEARCH DESIGN AND METHODSbAs
part of a service audit, deliveries to women with diabetes at a single South
Auckland hospital were reviewed from 1991 through 1994. Glycemic control was
estimated by the mean of self-recorded and laboratory postprandial glucose
concentrations. In a nested case-control study, pregnancies complicated by
GDM/type 2 diabetes with use of an insulin pump were compared with those
without insulin pump therapy and peak insulin requirements of 100b199 units/
day, matched for ethnicity and type of diabetes. RESULTSbA total of 30 of
Polynesian, European, and South Asian women with singleton pregnancies
complicated by insulin-requiring GDM/type 2 diabetes used an insulin pump. An
additional two women with high insulin requirements discontinued pump
therapy. None of the women with GDM/type 2 diabetes experienced severe
hypoglycemia, whereas 79% of the women had improved glycemic control within
4 weeks. Mothers using a pump had greater insulin requirements (median
maximum 246 vs. 130 units per day) and greater weight gain (10.6 vs. 5.0 kg).
Their babies were more likely to be admitted to the Special Care Baby Unit
but were neither significantly heavier nor experienced greater hypoglycemia
than control subjects. CONCLUSIONSbInsulin pump therapy seems to be safe and
effective for maintaining glycemic control in pregnancies complicated by
GDM/type 2 diabetes and requiring large doses of insulin. Abbreviations:
ADIPS, Australasian Diabetes in Pregnancy Society b" GDM, gestational
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