Adaptability of Closed-Loop during Labor, Delivery, and Postpartum—A Secondary Analysis of Data From Two Randomized Crossover Trials in Type 1 Diabetes Pregnancy
| العنوان: | Adaptability of Closed-Loop during Labor, Delivery, and Postpartum—A Secondary Analysis of Data From Two Randomized Crossover Trials in Type 1 Diabetes Pregnancy |
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| المؤلفون: | Helen R. Murphy, Zoe A. Stewart, Jennifer M. Yamamoto, Sara Hartnell, Malgorzata E. Wilinska, Roman Hovorka |
| المصدر: | Diabetes. 67 |
| بيانات النشر: | American Diabetes Association, 2018. |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | Type 1 diabetes, Pregnancy, medicine.medical_specialty, business.industry, Obstetrics, Endocrinology, Diabetes and Metabolism, Neonatal hypoglycemia, medicine.disease, Secondary analysis, Internal Medicine, medicine, Observational study, Tight glucose control, business, Closed loop, Postpartum period |
| الوصف: | Our aim was to evaluate the efficacy of closed-loop insulin delivery for maintaining glucose control in women with type 1 diabetes during labor, delivery and the immediate postpartum period. We report on data collected from two randomized crossover trials examining closed-loop in pregnancy. This is an observational study of women who chose to continue closed-loop during labor, delivery and 48-hour postpartum period. Of the 32 women in these trials, 27 (84.4%) continued closed-loop during this time. Women who used closed-loop during labor and delivery spent 82.0% (IQR 49.3, 93.0) of time in the target range, with a mean glucose level of 124.2±25.4 mg/dl. Closed-loop performed well throughout all modes of delivery (Table 1). In the 48-hour postpartum period, the mean glucose was 130±25.0 mg/dl. During this time women spent 83.3% (IQR 75.2, 94.6) time-in-target range. There was no difference in mean glucose in mothers of infants with neonatal hypoglycemia vs. those without (mean maternal glucose of 124.2±28.8 and 122.4±19.8 mg/dL respectively; p=0.84). This study demonstrates that closed-loop insulin delivery is safe and effective in labor, delivery and the immediate postpartum period. Future research is needed to compare the biomedical efficacy of closed-loop with intensive insulin therapy and intrapartum sliding scale approaches.Table 1: Glucose control during labor and delivery by mode of deliveryVaginal Delivery n=4Emergency Caesarean Section n=12Elective Caesarian Section n=11Mean glucose (mg/dl)113.1±2.7126.1±27.0126.2±28.7Median time-in-target in %84.3 (74.7, 88.8)84.4 (48.5, 93.7)76.5 (48.2, 93.0Median time below target in %0 (0, 3.4)0.8 (0, 2.0)0 (0, 2.2)Median time above target in %15.7 (11.2, 22.0)11.4 (6.3, 50.4)16.5 (7.1, 51.8)Median number of hypoglycemic events0 (0, 1.0)0 (0, 1.0)0 (0, 1.0)Number of women with a hypoglycemic event133 Disclosure J.M. Yamamoto: None. Z.A. Stewart: None. M.E. Wilinska: None. S. Hartnell: Speaker's Bureau; Self; Medtronic, Roche Pharma. R. Hovorka: Speaker's Bureau; Self; Novo Nordisk A/S. Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Eli Lilly and Company, AstraZeneca. Other Relationship; Self; B. Braun Medical Inc.. Research Support; Self; Medtronic. Other Relationship; Self; Medtronic. Research Support; Self; Abbott, JDRF, Diabetes UK, National Institute of Diabetes and Digestive and Kidney Diseases. H.R. Murphy: Advisory Panel; Self; Medtronic MiniMed, Inc.. Research Support; Self; Abbott. |
| تدمد: | 1939-327X 0012-1797 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_________::761487cb2cb7be0e27eef3599c7168f9Test https://doi.org/10.2337/db18-1432-pTest |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi...........761487cb2cb7be0e27eef3599c7168f9 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 1939327X 00121797 |
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