Normalization of pregnancy outcome in pregestational diabetes through functional insulin treatment and modular out-patient education adapted for pregnancy

• Published in: Diabetic medicine Vol. 18; no. 12; pp. 965 - 972
• Main Authors: Howorka, K., Pumprla, J., Gabriel, M., Feiks, A., Schlusche, C., Nowotny, C., Schober, E., Waldhoer, T., Langer, M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-12-2001; Blackwell
• Subjects: Adult; Biological and medical sciences; Birth Weight; Blood Glucose - metabolism; Case-Control Studies; Cesarean Section - statistics & numerical data; Congenital Abnormalities - epidemiology; Diabetes, Gestational - drug therapy; Diabetes, Gestational - rehabilitation; Female; functional insulin treatment; Gestational Age; Glycated Hemoglobin A - analysis; Hormones. Endocrine system; Humans; Hypoglycemia - epidemiology; Infant, Newborn; Insulin - therapeutic use; macrosomia; Medical sciences; Middle Aged; Patient Education as Topic; Pharmacology. Drug treatments; pregestational diabetes; Pregnancy; Pregnancy in Diabetics - drug therapy; Pregnancy in Diabetics - rehabilitation; Pregnancy Outcome; Reference Values; structured group education; United Kingdom; Europe; Austria; Human; Chemotherapy; Treatment; Indication; Diabetes mellitus; Female; Application method; Insulin; Recommendation; Public health
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1046/j.1464-5491.2001.00621.x

Aim  To investigate whether modular out‐patient group education for flexible, Functional Insulin Treatment (FIT) adapted for pregnancy can eliminate diabetes‐associated neonatal complications in pregestational diabetes.
Research design and methods  Outcome analysis of the modular out‐patient group education and FIT based on separate insulin dosages for fasting, eating or correcting hyperglycaemia in 76 consecutive pregnancies (in 20 cases first after conception) of 59 patients with pregestational diabetes (Type 1 diabetes, n = 54). Controls: (a) diabetic pregnancies: historical controls; (b) non‐diabetic pregnancies: retrospective case‐controlled study; (c) population‐based data of all Austrian newborns registered within the respective time period.
Results  HbA1c of 113 ± 18% of mean value (= 100%) of non‐diabetic, non‐pregnant population (103 ± 14% during the last pregnancy trimester), and self‐monitored blood glucose of 5.6 ± 0.7 mmol/l (5.3 ± 0.7 mmol/l during the last trimester) was achieved throughout all FIT pregnancies. Severe hypoglycaemia occurred in 14 pregnancies. The gestational age at delivery was 39.2 ± 1.5 weeks (four cases (5.4%) < 37 weeks) with a birth weight of 3305 ± 496 g. Four newborns (5.3%) were above the 90th, and nine (11.8%) below the 10th percentile for weight of reference population‐based data. Hypoglycaemia was recorded in six newborns (8%). Malformations were found in two infants whose mothers booked for diabetes FIT education only after conception. The caesarean delivery rate was 25%. In comparison with historical diabetic pregnancy controls we demonstrated a reduction in major complications, and compared with non‐diabetic women, a lowering of diabetes‐related neonatal complication rates to general population levels.
Conclusions  Structured, comprehensive, modular out‐patient group education promoting self‐choice of insulin dose for flexible, normal eating prior to conception normalizes pregnancy outcome in diabetes.
Diabet. Med. 18, 965–972 (2001)