NEW YORK (Reuters Health) – Insulin requirement increases with parity in pregnant women with type 1 diabetes, researchers from Denmark report.
“We were intrigued to find such a strong correlation between increasing parity and insulin requirements,” Dr. Gitte O. Skajaa from Aarhus University Hospital told Reuters Health by email. “Even after we adjusted for possible confounders (pre-pregnancy BMI, pre-pregnancy HbA1c, age, and duration of type 1 diabetes), the correlation was still clear.”
During normal pregnancy, peripheral insulin sensitivity diminishes as a result of rising levels of diabetogenic placental hormones. Some studies have shown an increase in the incidence of type 2 diabetes with increasing parity, while others have found no such association. It is clear, though, that the progression of insulin requirement during pregnancy varies considerably between women.
To investigate, Dr. Skajaa’s team evaluated insulin requirements during 536 pregnancies in 380 women with type 1 diabetes. Overall, insulin requirement decreased by 4% from baseline values at weeks 11-16 of pregnancy and rose by 70% at weeks 33-36 of pregnancy. At the end of pregnancy, insulin requirements were 66% higher than before pregnancy.
Mean daily insulin requirements for the entire pregnancy increased with parity, the researchers report in The Journal of Clinical Endocrinology & Metabolism. After adjustment for other important variables, insulin requirements were 13% higher during the second pregnancy, 20% higher during the third pregnancy and 36% higher in subsequent pregnancies compared with the first pregnancy (all P<0.0005).
“As the largest study of its kind, our study is able to give some valuable and precise estimates on the course of insulin requirement for all type 1 diabetes pregnancies,” Dr. Skajaa said. “This could help physicians when managing insulin dosages to pregnant women with type 1 diabetes, regardless of their parity, and give the women useful information on what to expect during their pregnancies.”
“We should keep in mind that a pregnant woman who already has 2 or 3 children might need more insulin than you would expect as her physician – only due to her parity,” she said. “This is also valuable information for her in the beginning of her pregnancy when asking what she can expect in the current pregnancy in comparison with her former pregnancies.”
Dr. Silver K. Bahendeka, a diabetes expert at MKPGMS-Uganda Martyrs University, St. Francis Hospital, in Kampala, Uganda, told Reuters Health by email, “Patient care has to be individualized all the time, and the requirements change with different physiological states.”
“More studies are needed in other conditions affecting type 1 diabetes so as to understand it better and improve the outcome of management,” said Dr. Bahendeka.
SOURCE: https://bit.ly/2GMCzHS
J Clin Endocrinol Metab 2018.
Tidak ada komentar:
Posting Komentar