Insulin pump use in pregnancy is associated with lower HbA1c without increasing the rate of severe hypoglycaemia or diabetic ketoacidosis in women with type 1 diabetes.

AIMS/HYPOTHESIS: The aim of this study was to compare glycaemic control and maternal-fetal outcomes in women with type 1 diabetes managed on insulin pumps compared with multiple daily injections of insulin (MDI). METHODS: In a retrospective study, glycaemic control and outcomes of 387 consecutive pregnancies in women with type 1 diabetes who attended specialised clinics at three centres 2006-2010 were assessed. RESULTS: Women using insulin pumps (129/387) were older and had a longer duration of diabetes, more retinopathy, smoked less in pregnancy, and had more preconception care (p < 0.01 for each). Among 113 pregnancies >20 weeks' gestation in women on insulin pumps and 218 in women on MDI, there was a significant difference in HbA1c in the first trimester (mean HbA1c 6.90 ± 0.71% (52 ± 7.8 mmol/mol) vs 7.60 ± 1.38% (60 ± 15.1 mmol/mol), p < 0.001), which persisted until the third trimester (mean HbA1c 6.49 ± 0.52% (47 ± 5.7 mmol/mol) vs 6.81 ± 0.85% (51 ± 9.3 mmol/mol), p = 0.002). Rates of diabetic ketoacidosis were similar in women on insulin pumps vs MDI (1.8% vs 3.0%, p = 0.72). Despite lower HbA1c, women on insulin pumps did not have an increased incidence of severe hypoglycaemia (8.0% vs 7.6%, p = 0.90) or more weight gain (16.3 ± 8.7 vs 15.2 ± 6.2 kg, p = 0.18). More large-for-gestational-age infants in the pump group (55.0% vs 39.2%, p = 0.007) may have resulted from confounding by parity. CONCLUSIONS/INTERPRETATION: In this large multicentre study, women using insulin pumps in pregnancy had lower HbA1c without increased risk of severe hypoglycaemia or diabetic ketoacidosis but no improvement in other pregnancy outcomes. This information can help inform care providers and patients about the glycaemic effectiveness and safety of insulin pumps in pregnancy.

Optimizing Type 2 Diabetes Management in a Medically Complex Patient: A Case Report of a Patient with Type 2 Diabetes and HIV.

Background: The prevalence of diabetes is rapidly escalating, with projections indicating that 783 million individuals aged 20-79 years worldwide will be affected by diabetes. This rise is concurrent with a persistent prevalence of HIV in developing nations, while conventional risk factors such as sedentary lifestyle and unhealthy diet may account for this trend, HIV and its treatment have emerged as potential contributing factors. Achieving optimal diabetes control in patients with HIV necessitates a profound understanding of the intricate interplay between the two diseases and their respective treatments. Case Report: We present a case involving a patient with long standing type 2 diabetes, coexisting HIV infection and hypertension. Despite receiving high doses of insulin, as advised by most diabetes guidelines, the patient's diabetes remained poorly controlled. In lieu of strictly adhering to guidelines, our primary focus was to conduct a comprehensive reevaluation of the patient's medications, prioritizing the development of streamlined and safe treatment regimens for all three of her medical conditions. Employing this strategy, we observed swift improvement in blood glucose levels, leading to successful diabetes control within one year. Conclusion: This case underscores the importance of individualizing diabetes management in patients with multiple comorbidities. It highlights the significance of reassessing treatment approaches beyond standard guidelines, with a focus on tailoring therapy to suit the unique needs and complexities of each patient's medical profile. Such personalized interventions hold promise for achieving optimal diabetes control in individuals with diverse comorbidities.

Case Series of U-500 Insulin Use in Adults With Type 2 Diabetes and Severe Insulin Resistance.

OBJECTIVES: Severe insulin resistance results in large volumes of insulin to achieve glycemic control. These large volumes can result in patient discomfort and decreased satisfaction. Using the more concentrated U-500 insulin provides a solution to this problem. This case series demonstrates real-world use of U-500 insulin in a Canadian population. METHODS: Seventeen patients were identified to have been started on U-500 insulin at an endocrinology clinic in Vancouver, British Columbia, Canada. The retrospective chart review looked at patients' characteristics before starting U-500 insulin and at their 1-year follow-up appointment. RESULTS: At follow up, patients demonstrated improved glycated hemoglobin with a mean improvement of 1.6% at 1 year (p<0.05). There was a statistically significant increase in hypoglycemia (p<0.05), and, on average, patients gained 5.6 kg over the course of the year (p<0.05). There was no statistically significant change in number of units of insulin, injections, lipids, renal function or blood pressure. CONCLUSIONS: The initiation of U-500 insulin results in improved glycemic control at the cost of increased hypoglycemia and weight gain.

The prevalence of gestational diabetes mellitus and glucose abnormalities in pregnant women with hepatitis C virus infection in British Columbia.

OBJECTIVE: There is evidence to support an association between diabetes mellitus (DM) and hepatitis C virus (HCV) infection. The insulin resistant state of pregnancy suggests a predisposition to developing gestational diabetes mellitus (GDM) in women infected with HCV. The aim of this study was to compare the prevalence of GDM and impaired glucose tolerance (IGT) of pregnancy between women infected with HCV and the general population of British Columbia screened for GDM. METHODS: The HCV cohort was drawn from a population-based prospective cohort of 148 pregnant women infected with HCV in British Columbia. GDM screening tests were completed in 84 women. The prevalence of GDM and IGT of pregnancy in the general population of British Columbia was estimated by acquiring 24 321 GDM screening tests performed by the two major laboratories in the province. RESULTS: Non-compliance was the primary reason for incomplete screening. The prevalence of GDM was 9.5% in the HCV cohort and 6.8% in the screened general population (chi-square test P = 0.33). Similarly, there was no difference in IGT of pregnancy between the two cohorts (2.4% vs. 3.5%; chi-square test P = 0.57). CONCLUSION: A difference in the prevalence of either GDM or IGT of pregnancy was not detected between HCV-infected patients who were screened for GDM and those screened in the general population. Further studies are required to assess whether HCV infection is an independent risk factor for GDM.

Evaluation of the International Association of the Diabetes In Pregnancy Study Group new criteria: gestational diabetes project.

OBJECTIVE: To examine the diagnostic rates of gestational diabetes (GDM) and maternal/fetal outcomes before and after replacement of the Carpenter and Coustan (C&C) criteria with the International Association Diabetes Pregnancy Study Group (IADPSG) criteria. METHODS: A retrospective analysis of all pregnancies in 2 separate 6-month cohorts in the province of British Columbia. The first C&C cohort was defined as a 6-month period prior to the introduction of the IADPSG 75 g glucose tolerance test on October 1, 2010. The IADPSG cohort was studied during a 6-month period after the change. RESULTS: There was a significant increase in rates of GDM when using the IADPSG 75 g criteria, from 7.9% (1838 of 23 211) to 9.4% (2104 of 22 397). There were no significant changes in maternal outcomes when using the IADPSG criteria (caesarean section, induction of labour, perineal laceration, pregnancy-induced hypertension, antepartum hemorrhage >20 weeks or postpartum hospital length of stay). The caesarean section rate was not increased according to multivariate analysis (30.9% vs. 29.7%; p=0.073). There were no significant changes in most fetal outcomes when using the IADPSG criteria (mean gestational age at birth, premature birth, meconium, birth trauma, mean birth weight, large for gestational age, small for gestational age, intrauterine growth restriction), but neonatal hypoglycemia was significantly higher (1.6 % vs. 1.3 %; p=0.007). CONCLUSIONS: The rates of GDM were higher when using the new IADPSG criteria. Overall, all of the maternal and most of the fetal outcomes were similar.