Endocrine Abstracts

Introduction: To investigate whether the incidence of severe hypoglycaemia in pregnant women with type 1 diabetes can be reduced without deteriorating pregnancy outcomes in a routine care setting.

Methods/design: A new cohort (2009–2011) of 59 women receiving intensified education about the risk of severe hypoglycaemia in pregnancy was compared with an old cohort (2004–2006) of 108 women. The women entered the study at median 8 (range 5–13) weeks. Severe hypoglycaemia (requiring assistance from others) was prospectively reported in structured interviews.

Results: In the new vs old cohort HbA1c was comparable at inclusion (6.8% (5.6–10.7) vs 6.6% (4.9–10.5), P=0.25). During pregnancy severe hypoglycaemia occurred in 25% (n=15) vs 45% (n=49), P=0.01, corresponding to an incidence of 1.3 vs 2.5 events/patient-year, P=0.04. Repeated severe hypoglycaemia occurred in 7% (n=4) vs 31% (n=34), P=0.0003. At inclusion a higher proportion of women in the new vs old cohort were on insulin analogues (rapid-acting 100 vs 44%, P<0.0001; long-acting 53 vs 6%, P<0.0001) and insulin pumps (24 vs 5%, P=0.0002). Insulin dose at 8 weeks was lower in women on multiple daily injections in the new vs old cohort (0.67 IU/kg (0.3–1.4) vs 0.77 (0.4–1.7), P=0.02) and similar in women on insulin pumps (0.54 IU/kg (0.4–1.1) vs 0.59 (0.3–0.9), P=0.85). Pregnancy outcomes were similar in the two cohorts. At multivariate logistic regression analysis, insulin dose at 8 weeks (OR 8.2 (95% CI: 1.6–41.9), P=0.01), severe hypoglycaemia in the year preceding pregnancy (6.0 (2.6–13.7), P<0.0001) and impaired hypoglycaemia awareness (4.8 (2.2–10.3), P<0.0001) were associated with severe hypoglycaemia.

Conclusion: A lower incidence of severe hypoglycaemia in pregnancy without deteriorated pregnancy outcomes was observed in a routine care setting. Lower insulin dose in early pregnancy and focus on high-risk patients may contribute.