Real-World Evidence of Off-Label Use of Commercially Automated Insulin Delivery Systems Compared to Multiple Daily Insulin Injections in Pregnancies Complicated by Type 1 Diabetes.

Aims: To compare glycemic control and maternal-fetal outcomes of women with type 1 diabetes (T1D) using hybrid closed loop (HCL) versus multiple daily insulin injections (MDI) plus continuous glucose monitoring. Methods: Multicenter prospective cohort study of pregnant women with T1D in Spain. We evaluated HbA1c and time spent within (TIR), below (TBR), and above (TAR) the pregnancy-specific glucose range of 3.5-7.8 mmol/L. Adjusted models were performed for adverse pregnancy outcomes, including baseline maternal characteristics and center. Results: One hundred twelve women were included (HCL n = 59). Women in the HCL group had a longer duration of diabetes and higher rates of prepregnancy care. There was no between-group difference in HbA1c in any trimester. However, in the second trimester, MDI users had a greater decrease in HbA1c (-6.12 ± 9.06 vs. -2.16 ± 7.42 mmol/mol, P = 0.031). No difference in TIR (3.5-7.8 mmol/L) and TAR was observed between HCL and MDI users, but with a higher total insulin dose in the second trimester [+0.13 IU/kg·day)]. HCL therapy was associated with increased maternal weight gain during pregnancy (ßadjusted = 3.20 kg, 95% confidence interval [CI] 0.90-5.50). Regarding neonatal outcomes, newborns of HCL users were more likely to have higher birthweight (ßadjusted = 279.0 g, 95% CI 39.5-518.5) and macrosomia (ORadjusted = 3.18, 95% CI 1.05-9.67) compared to MDI users. These associations disappeared when maternal weight gain or third trimester HbA1c was included in the models. Conclusions: In a real-world setting, HCL users gained more weight during pregnancy and had larger newborns than MDI users, while achieving similar glycemic control in terms of HbA1c and TIR.

Fasting Glucose for the Diagnosis of Gestational Diabetes Mellitus (GDM) during the COVID-19 Pandemic.

Background: During the COVID-19 pandemic, different non-validated tests were proposed to simplify the diagnosis of gestational diabetes (GDM). Aim: To analyse the effects of replacing the two-step approach for Early-GDM and GDM diagnosis, with a fasting plasma glucose test. Material and Methods: This is a cohort study consisting of 3200 pregnant women: 400 with Early-GDM, 800 with GDM and 2000 with Non-GDM diagnosed using the two-step approach. Using fasting plasma glucose for Early-GDM and GDM diagnosis, according to the recommendations of Spain, Australia, Italy and the UK during the pandemic, the rates of missed and new Early-GDM and GDM were calculated and perinatal outcomes were analysed. Results: Using fasting plasma glucose in the first trimester >100 mg/dL for Early-GDM diagnosis, the rates of post-COVID missed and new Early-GDM were 79.5% and 3.2%, respectively. Using fasting plasma glucose at 24−28 weeks <84 or >92, 95 or 100 mg/dL for GDM diagnosis, the rates of missed GDM were 50.4%, 78%, 82.6% and 92.4%, respectively, and 8.6%, 5.6% and 2.3% women with Non-GDM were diagnosed with new GDM. Conclusion: Fasting plasma glucose is not a good test for the diagnosis of GDM either in the first trimester or at 24−28 weeks.

Diabetes in Pregnancy and MicroRNAs: Promises and Limitations in Their Clinical Application.

Maternal diabetes is associated with an increased risk of complications for the mother and her offspring. The latter have an increased risk of foetal macrosomia, hypoglycaemia, respiratory distress syndrome, preterm delivery, malformations and mortality but also of life-long development of obesity and diabetes. Epigenetics have been proposed as an explanation for this long-term risk, and microRNAs (miRNAs) may play a role, both in short- and long-term outcomes. Gestation is associated with increasing maternal insulin resistance, as well as ß-cell expansion, to account for the increased insulin needs and studies performed in pregnant rats support a role of miRNAs in this expansion. Furthermore, several miRNAs are involved in pancreatic embryonic development. On the other hand, maternal diabetes is associated with changes in miRNA both in maternal and in foetal tissues. This review aims to summarise the existing knowledge on miRNAs in gestational and pre-gestational diabetes, both as diagnostic biomarkers and as mechanistic players, in the development of gestational diabetes itself and also of short- and long-term complications for the mother and her offspring.

Control preconcepcional en la diabetes: factores predisponentes y barreras / Preconception care in diabetes: Predisposing factors and barriers

Antecedentes y objetivo: El control preconcepcional ha demostrado reducir el riesgo del embarazo asociado a la diabetes, pero muchas mujeres siguen quedando gestantes sin planificación previa. Nuestro objetivo fue identificar los factores predisponentes y las barreras relacionadas con la realización de control preconcepcional. Material y métodos: Se incluyeron, de forma consecutiva, 50 mujeres con diabetes pregestacional (28 tipo 1) y 50 gestantes sin diabetes que acudían a nuestro centro. Se les pidió que cumplimentaran un cuestionario y se revisaron sus historias clínicas. Resultados: Las 33 pacientes con diabetes y control preconcepcional tenían una edad actual (34,3±5,3 años) y al diagnóstico de la diabetes (20,3±11,3 años) similares a las 17 pacientes sin control (31,8±5,3 y 19,1±10,6 años, respectivamente; p>0,1), pero estaban con más frecuencia viviendo en pareja (97% vs. 70,6%; p=0,014), laboralmente activas (69,7% vs. 29,4%; p=0,047), eran seguidas por un/a endocrinólogo/a (80,6% vs. 50%; p=0,034), habían tenido abortos previos (78,6% vs. 10%; p=0,001), y conocían la repercusión de la diabetes en el embarazo (87,5% vs. 58,8%; p=0,029). No hubo diferencias significativas en la toma de ácido fólico pregestacional entre las gestantes con y sin diabetes (23,8% vs. 32%; p>0,1). Conclusiones: En las pacientes con diabetes, acudir a control preconcepcional se asoció con vivir en pareja, estar laboralmente activas, conocer el riesgo de complicaciones, tener abortos previos y ser seguidas por un/a endocrinólogo/a. Existe un bajo porcentaje de preparación de la gestación, también en el grupo sin diabetes (AU)

Background and objective: Preconception care has been shown to decrease the risk of pregnancy-related complications in women with diabetes, but many women do not plan their pregnancies. Our aim was to identify the associated factors and barriers related to involvement of these women in preconception care. Material and methods: Fifty women with pregestational diabetes (28 with type 1 diabetes) and 50 non-diabetic pregnant women were consecutively enrolled at our hospital. They completed a questionnaire, and their medical histories were reviewed. Results: All 33 patients with diabetes who received preconception care had a similar current age (34.3±5.3 years) and age at diagnosis (20.3±11.3) than those with no preconception care (n=17) (31.8±5.3 and 19.1±10.6 years respectively; P>.1), but were more frequently living with their partners (97% vs. 70.6%; P=.014), employed (69.7% vs. 29.4%; P=.047), and monitored by an endocrinologist (80.6% vs. 50%; P=.034), had more commonly had previous miscarriages (78.6% vs. 10%; P=.001), and knew the impact of diabetes on pregnancy (87.5% vs. 58.8%; P=.029). The frequency of preconceptional folic acid intake was similar in pregnant women with and without diabetes (23.8% vs. 32%; P>.1). Conclusions: Preconception care of diabetic patients is associated to living with a partner, being employed, knowing the risks of pregnancy-related complications, having previous miscarriages, and being monitored by an endocrinologist. Pregnancy planning is infrequent in both women with and without diabetes (AU)

Preconception care in diabetes: Predisposing factors and barriers. / Control preconcepcional en la diabetes: factores predisponentes y barreras.

BACKGROUND AND OBJECTIVE: Preconception care has been shown to decrease the risk of pregnancy-related complications in women with diabetes, but many women do not plan their pregnancies. Our aim was to identify the associated factors and barriers related to involvement of these women in preconception care. MATERIAL AND METHODS: Fifty women with pregestational diabetes (28 with type 1 diabetes) and 50 non-diabetic pregnant women were consecutively enrolled at our hospital. They completed a questionnaire, and their medical histories were reviewed. RESULTS: All 33 patients with diabetes who received preconception care had a similar current age (34.3±5.3 years) and age at diagnosis (20.3±11.3) than those with no preconception care (n=17) (31.8±5.3 and 19.1±10.6 years respectively; P>.1), but were more frequently living with their partners (97% vs. 70.6%; P=.014), employed (69.7% vs. 29.4%; P=.047), and monitored by an endocrinologist (80.6% vs. 50%; P=.034), had more commonly had previous miscarriages (78.6% vs. 10%; P=.001), and knew the impact of diabetes on pregnancy (87.5% vs. 58.8%; P=.029). The frequency of preconceptional folic acid intake was similar in pregnant women with and without diabetes (23.8% vs. 32%; P>.1). CONCLUSIONS: Preconception care of diabetic patients is associated to living with a partner, being employed, knowing the risks of pregnancy-related complications, having previous miscarriages, and being monitored by an endocrinologist. Pregnancy planning is infrequent in both women with and without diabetes.

Factitious hypoglycemia in pregnancy in a patient with type 2 diabetes.

BACKGROUND: Glycemic control in pregnancy complicated by diabetes is important. Spontaneous symptomatic hypoglycemia, in the absence of glucose-lowering treatment, is rare and requires evaluation to prevent harm. CASE: As a result of hypoglycemia, a pregnant woman with type 2 diabetes mellitus had progressive reduction of her insulin requirements until treatment was discontinued at 27 weeks. Despite this, she reported persistent episodes of hypoglycemia. Investigation of possible causes resulted in the discovery that she was covertly treating herself with insulin. CONCLUSION: Factitious hypoglycemia should be considered as part of the differential diagnosis of unexplained hypoglycemia. Blood sampling during an episode of hypoglycemia is pivotal in this assessment.