Prevalence of Hypoglycaemia among Insulin-Treated Pregnant Women with Diabetes- who achieved Tight Glycaemic Control

Authors

DOI:

https://doi.org/10.15605/jafes.034.01.06

Keywords:

hypoglycaemia, continuous glucose monitoring system, pregnancy, diabetes mellitus

Abstract

Objective.To determine the prevalence of hypoglycaemia using continuous glucose monitoring system (CGMS) among insulin-treated pregnant women with diabetes whose glycosylated haemoglobin (HbA1c) were

Methodology.We conducted a cross-sectional study using 6-days CGMS to detect the prevalence of hypoglycaemia in 31 insulin-treated pregnant women with diabetes who achieved HbA1c

Results. Eight women experienced confirmed hypoglycaemia with additional seven experienced relative hypoglycaemia, giving rise to prevalence rate of 45.2% (one had both confirmed and relative hypoglycaemia). Nine relative hypoglycaemia and 17 confirmed hypoglycaemic events were recorded. Sixteen (94%) out of 17 confirmed hypoglycaemia events recorded by CGMS were asymptomatic and were missed despite performing regular SMBG. Nocturnal hypoglycaemia events were recorded in seven women. Univariable analysis did not identify any association between conventional risk factors and hypoglycaemia events in our cohort.

Conclusion. Insulin-treated pregnant women with diabetes who achieved HbA1c < 6.0% were associated with high prevalence of hypoglycaemia. Asymptomatic hypoglycaemia is common in our cohort and frequently missed despite regular SMBG. Present study did not identify any association between conventional risk factors and hypoglycaemia events in our cohort.

Downloads

Download data is not yet available.

Author Biographies

Danish Ng, Tengku Ampuan Rahimah Hospital, Klang, Ministry of Health

Department of Medicine

Nurain Mohd Noor, Putrajaya Hospital, Ministry of Health

Department of Medicine

Sy Liang Yong, Tengku Ampuan, Rahimah Hospital, Klang, MInistry of Health

Department of Medicine

References

Kitzmiller JL, Block JM, Brown FM, et al. Managing preexisting diabetes for pregnancy: Summary of evidence and consensus recommendations for care. Diabetes Care. 2008;31(5):1060-79. PMID: 18445730. PMCID: PMC2930883. https://doi.org/10.2337/dc08-9020.

HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991-2002. PMID: 18463375. https://doi.org/10.1056/NEJMoa0707943.

Group HSCR. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: Associations with neonatal anthropometrics. Diabetes. 2009;58(2):453-9. PMID: 19011170. PMCID: PMC2628620. htpps://doi.org/10.2337/db08-1112.

Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: Association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005;115(3):e290-6. PMID: 15741354. https://doi.org/10.1542/peds.2004-1808.

Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: A systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med 2013;159(2):123-9. PMID: 23712381. https://doi.org/10.7326/0003-4819-159-2-201307160-00661.

American Diabetes Association. (12) Management of diabetes in pregnancy. Diabetes Care. 2015;38 Suppl:S77-9. PMID: 25537713. https://doi.org/10.2337/dc15-S015.

Evers IM, ter Braak EW, de Valk HW, van Der Schoot B, Janssen N, Visser GH. Risk indicators predictive for severe hypoglycemia during the first trimester of type 1 diabetic pregnancy. Diabetes are 2002;25(3):554-9. PMID: 11874946.

Yogev Y, Chen R, Ben-Haroush A, Phillip M, Jovanovic L, Hod M. Continuous glucose monitoring for the evaluation of gravid women with type 1 diabetes mellitus. Obstet Gynecol. 2003;101(4):633-8. PMID: 12681863.

Nielsen LR, Pedersen-Bjergaard U, Thorsteinsson B, Johansen M, Damm P, Mathiesen ER. Hypoglycemia in pregnant women with type 1 diabetes: Predictors and role of metabolic control. Diabetes Care. 2008;31(1):9-14. PMID: 17909091. https://doi.org/10.2337/dc07-1066.

Chen R, Yogev Y, Ben-Haroush A, Jovanovic L, Hod M, Phillip M. Continuous glucose monitoring for the evaluation and improved control of gestational diabetes mellitus. J Matern Fetal Neonatal Med 2003;14(4):256-60. PMID: 14738172. https://doi.org/10.1080/jmf.14.4.256.260.

Shafiee G, Mohajeri-Tehrani M, Pajouhi M, Larijani B. The importance of hypoglycemia in diabetic patients. J Diabetes Metab Disord. 2012;11:17. https://doi.org/10.1186/2251-6581-11-17.

Juvenile Diabetes Research foundation Continuous Glucose Monitoring Study group, Tamborlane WV, Beck RW, et al. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med 2008;359(14):1464-76. PMID: 18779236. https://doi.org/10.1056/NEJMoa0805017.

Murphy HR, Rayman G, Lewis K, et al. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: Randomised clinical trial. BMJ. 2008;337:a1680. PMID: 18818254. PMCID: PMC2563261. https://doi.org/10.1136/bmj.a1680.

Battelino T, Phillip M, Bratina N, Nimri R, Oskarsson P, Bolinder J. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care. 2011;34(4):795-800. PMID: 21335621. PMCID: PMC3064030. https://doi.org/10.2337/dc10-1989.

Blevins TC, Bode BW, Garg SK, et al. Statement by the American Association of Clinical Endocrinologists Consensus Panel on continuous glucose monitoring. Endocr Pract. 2010;16(5):730-45. PMID: 21356637. https://doi.org/10.4158/EP.16.5.730.

American Diabetes A. (6) Glycemic targets. Diabetes Care. 2015;38 Suppl:S33-40. PMID: 25537705. https://doi.org/10.2337/dc15-S009.

American Diabetes Association. (2) Classification and diagnosis of diabetes. Diabetes Care. 2015;38 Suppl:S8-16. PMID: 25537714. https://doi.org/10.2337/dc15-S005.

Naing L Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Arch Orofac Sci. 2006;1(1):9-14.

Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: A report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013;36(5):1384-95. PMID: 23589542. PMCID: PMC3631867. https://doi.org10.2337/dc12-2480.

International Hypoglycaemia Study G. Glucose concentrations of less than 3.0 mmol/L (54 mg/dL) should be reported in clinical trials: A joint position statement of the American Diabetes Association and the European Association for the study of diabetes. Diabetes Care. 2017;40(1):155-7. PMID: 27872155. https://doi.org/10.2337/dc16-2215.

Robertson H, Pearson DWM, Gold AE. Severe hypoglycaemia during pregnancy in women with type 1 diabetes is common and planning pregnancy does not decrease the risk. Diabet Med. 2009;26(8):824-6. https://doi.org/10.1111/j.1464-5491.2009.02769.x.

Heller S, Damm P, Mersebach H, et al. Hypoglycemia in type 1 diabetic pregnancy: Role of preconception insulin aspart treatment in a randomized study. Diabetes Care. 2010;33(3):473-7. PMID: 20007944. PMCID: PMC2827491. https://doi.org/10.2337/dc09-1605.

Mathiesen ER, Kinsley B, Amiel SA, et al. Maternal glycemic control and hypoglycemia in type 1 diabetic pregnancy: A randomized trial of insulin aspart versus human insulin in 322 pregnant women. Diabetes Care. 2007;30(4):771-6. PMID: 17392539. https://doi.org/10.2337/dc06-1887.

Ringholm L, Pedersen-Bjergaard U, Thorsteinsson B, Damm P, Mathiesen ER. Hypoglycaemia during pregnancy in women with type 1 diabetes. Diabet Med. 2012;29(5):558-66. PMID: 22313112. https://doi.org/10.1111/j.1464-5491.2012.03604.x.

Sacks DB, Arnold M, Bakris GL, et al. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care. 2011;34(6):e61-99. PMID: 21617108. PMCID: PMC3114322. https://doi.org/10.2337/dc11-9998.

American Diabetes Association. Standards of medical care in diabetes--2008. Diabetes Care. 2008;31(Suppl 1):S12-54. PMID: 18165335. https://doi.org/ 10.2337/dc08-S012.

Medtronic MiniMed I. iPro2 user guide, 2016. Available from https://www.medtronicdiabetes.com/sites/default/files/library/download-library/user-guides/iPro2-with-Enlite-User-Guide.pdf.

Kovatchev B, Anderson S, Heinemann L, Clarke W. Comparison of the numerical and clinical accuracy of four continuous glucose monitors. Diabetes Care. 2008;31(6):1160-4. PMID: 18339974. PMCID: PMC4607511.NIHMSID: NIHMS725705.https://doi.org/10.2337/dc07-2401.

Gross TM, Bode BW, Einhorn D, et al. Performance evaluation of the MiniMed continuous glucose monitoring system during patient home use. Diabetes Technol Ther. 2000;2(1):49-56. PMID: 11467320. https://doi.org/ 10.1089/152091500316737.

Gross TM, Ter Veer A. Continuous glucose monitoring in previously unstudied population subgroups. Diabetes Technol Ther. 2000;2(Suppl 1):S27-34. PMID: 11469629.

Rossi G, Lapaczewski P, Diamond MP, Jacob RJ, Shulman GI, Sherwin RS. Inhibitory effect of pregnancy on counterregulatory hormone responses to hypoglycemia in awake rat. Diabetes. 1993;42(10):1440-5. PMID: 8375583.

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Thompson D, Berger H, et al. Diabetes and pregnancy. Can J Diabetes 2013;37 (Suppl 1):S168-83. PMID: 24070943. https://doi.org/10.1016/j.jcjd.2013.01.044.

Bode B, Gross K, Rikalo N, et al. Alarms based on real-time sensor glucose values alert patients to hypo- and hyperglycemia: The guardian continuous monitoring system. Diabetes Technol Ther. 2004;6(2):105-13. PMID: 15117576. https://doi.org/10.1089/152091504773731285.

Keely E, Barbour LA. Management of diabetes in pregnancy. Available from https://www.ncbi.nlm.nih.gov/books/NBK279010/. Accessed 14 August 2015. Endotext [Internet]. South Dartmouth (MA):2000.

Rosenn BM, Miodovnik M, Holcberg G, Khoury JC, Siddiqi TA. Hypoglycemia: The price of intensive insulin therapy for pregnant women with insulin-dependent diabetes mellitus. Obstet Gynecol. 1995;85(3):417-22. PMID: 7862383. https://doi.org/10.1016/0029-7844(94)00415-A.

Jovanovic L, Knopp RH, Brown Z, et al. Declining insulin requirement in the late first trimester of diabetic pregnancy. Diabetes Care. 2001;24(7):1130-6. PMID: 11423491.

Garg SK, Frias JP, Anil S, Gottlieb PA, MacKenzie T, Jackson WE. Insulin lispro therapy in pregnancies complicated by type 1 diabetes: Glycemic control and maternal and fetal outcomes. Endocr Pract. 2003;9(3):187-93. PMID: 12917059. https://doi.org/10.4158/EP.9.3.187.

Nielsen LR, Pedersen-Bjergaard U, Thorsteinsson B, Boomsma F, Damm P, Mathiesen ER. Severe hypoglycaemia during pregnancy in women with type 1 diabetes: Possible role of renin-angiotensin system activity? Diabetes Res Clin Pract. 2009;84(1):61-7. PMID: 19188000. https://doi.org/10.1016/j.diabres.2009.01.006.

Published

2019-07-30

How to Cite

Ng, D., Mohd Noor, N., & Yong, S. L. (2019). Prevalence of Hypoglycaemia among Insulin-Treated Pregnant Women with Diabetes- who achieved Tight Glycaemic Control. Journal of the ASEAN Federation of Endocrine Societies, 34(1), 29. https://doi.org/10.15605/jafes.034.01.06

Issue

Section

Original Articles