The incidence of severe hypoglycaemia in pregnant women with type 1 diabetes mellitus can be reduced with unchanged HbA1c levels and pregnancy outcomes in a routine care setting

Lene Ringholm; A L Secher; U Pedersen-Bjergaard; B Thorsteinsson; H U Andersen; P Damm; E R Mathiesen

doi:10.1016/j.diabres.2013.06.002

The incidence of severe hypoglycaemia in pregnant women with type 1 diabetes mellitus can be reduced with unchanged HbA1c levels and pregnancy outcomes in a routine care setting

Lene Ringholm, A L Secher, U Pedersen-Bjergaard, B Thorsteinsson, H U Andersen, P Damm, E R Mathiesen

Department of Clinical Medicine

14 Citations (Scopus)

Abstract

Aims: To investigate whether the incidence of severe hypoglycaemia in pregnant women with type 1 diabetes can be reduced without deteriorating HbA1c levels or pregnancy outcomes in a routine care setting. Methods: Two cohorts (2004-2006; n= 108 and 2009-2011; n= 104) were compared. In between the cohorts a focused intervention including education of caregivers and patients in preventing hypoglycaemia was implemented. Women were included at median 8 (range 5-13) weeks. Severe hypoglycaemia (requiring assistance from others) was prospectively reported in structured interviews. Results: In the first vs. second cohort, severe hypoglycaemia during pregnancy occurred in 45% vs. 23%, p= 0.0006, corresponding to incidences of 2.5 vs. 1.6 events/patient-year, p= 0.04. Unconsciousness and/or convulsions occurred at 24% vs. 8% of events. Glucagon and/or glucose injections were given at 15% vs. 5% of events. At inclusion HbA1c was comparable between the cohorts while in the second cohort fewer women reported impaired hypoglycaemia awareness (56% vs. 36%, p= 0.0006), insulin dose in women on multiple daily injections was lower (0.77. IU/kg (0.4-1.7) vs. 0.65 (0.2-1.4), p= 0.0006) and more women were on insulin analogues (rapid-acting 44% vs. 97%, p< 0.0001; long-acting 6% vs. 76%, p< 0.0001) and insulin pumps (5% vs. 23%, p< 0.0001). Pregnancy outcomes were similar in the two cohorts. Conclusions: A 36% reduction in the incidence of severe hypoglycaemia in pregnancy with unchanged HbA1c levels and pregnancy outcomes was observed after implementation of focused intervention against severe hypoglycaemia in a routine care setting. Improved insulin treatment, increased health professional education and fewer women with impaired hypoglycaemia awareness may contribute.

Original language	English
Journal	Diabetes Research and Clinical Practice
Volume	101
Issue number	2
Pages (from-to)	123-130
Number of pages	8
ISSN	0168-8227
DOIs	https://doi.org/10.1016/j.diabres.2013.06.002
Publication status	Published - Aug 2013

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Ringholm, L., Secher, A. L., Pedersen-Bjergaard, U., Thorsteinsson, B., Andersen, H. U., Damm, P., & Mathiesen, E. R. (2013). The incidence of severe hypoglycaemia in pregnant women with type 1 diabetes mellitus can be reduced with unchanged HbA1c levels and pregnancy outcomes in a routine care setting. Diabetes Research and Clinical Practice, 101(2), 123-130. https://doi.org/10.1016/j.diabres.2013.06.002

The incidence of severe hypoglycaemia in pregnant women with type 1 diabetes mellitus can be reduced with unchanged HbA1c levels and pregnancy outcomes in a routine care setting. / Ringholm, Lene; Secher, A L; Pedersen-Bjergaard, U et al.

In: Diabetes Research and Clinical Practice, Vol. 101, No. 2, 08.2013, p. 123-130.

Research output: Contribution to journal › Journal article › Research › peer-review

Ringholm, L, Secher, AL, Pedersen-Bjergaard, U, Thorsteinsson, B, Andersen, HU, Damm, P & Mathiesen, ER 2013, 'The incidence of severe hypoglycaemia in pregnant women with type 1 diabetes mellitus can be reduced with unchanged HbA1c levels and pregnancy outcomes in a routine care setting', Diabetes Research and Clinical Practice, vol. 101, no. 2, pp. 123-130. https://doi.org/10.1016/j.diabres.2013.06.002

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title = "The incidence of severe hypoglycaemia in pregnant women with type 1 diabetes mellitus can be reduced with unchanged HbA1c levels and pregnancy outcomes in a routine care setting",

abstract = "Aims: To investigate whether the incidence of severe hypoglycaemia in pregnant women with type 1 diabetes can be reduced without deteriorating HbA1c levels or pregnancy outcomes in a routine care setting. Methods: Two cohorts (2004-2006; n= 108 and 2009-2011; n= 104) were compared. In between the cohorts a focused intervention including education of caregivers and patients in preventing hypoglycaemia was implemented. Women were included at median 8 (range 5-13) weeks. Severe hypoglycaemia (requiring assistance from others) was prospectively reported in structured interviews. Results: In the first vs. second cohort, severe hypoglycaemia during pregnancy occurred in 45% vs. 23%, p= 0.0006, corresponding to incidences of 2.5 vs. 1.6 events/patient-year, p= 0.04. Unconsciousness and/or convulsions occurred at 24% vs. 8% of events. Glucagon and/or glucose injections were given at 15% vs. 5% of events. At inclusion HbA1c was comparable between the cohorts while in the second cohort fewer women reported impaired hypoglycaemia awareness (56% vs. 36%, p= 0.0006), insulin dose in women on multiple daily injections was lower (0.77. IU/kg (0.4-1.7) vs. 0.65 (0.2-1.4), p= 0.0006) and more women were on insulin analogues (rapid-acting 44% vs. 97%, p< 0.0001; long-acting 6% vs. 76%, p< 0.0001) and insulin pumps (5% vs. 23%, p< 0.0001). Pregnancy outcomes were similar in the two cohorts. Conclusions: A 36% reduction in the incidence of severe hypoglycaemia in pregnancy with unchanged HbA1c levels and pregnancy outcomes was observed after implementation of focused intervention against severe hypoglycaemia in a routine care setting. Improved insulin treatment, increased health professional education and fewer women with impaired hypoglycaemia awareness may contribute.",

author = "Lene Ringholm and Secher, {A L} and U Pedersen-Bjergaard and B Thorsteinsson and Andersen, {H U} and P Damm and Mathiesen, {E R}",

year = "2013",

month = aug,

doi = "10.1016/j.diabres.2013.06.002",

language = "English",

volume = "101",

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journal = "Diabetes Research and Clinical Practice",

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T1 - The incidence of severe hypoglycaemia in pregnant women with type 1 diabetes mellitus can be reduced with unchanged HbA1c levels and pregnancy outcomes in a routine care setting

AU - Ringholm, Lene

AU - Secher, A L

AU - Pedersen-Bjergaard, U

AU - Thorsteinsson, B

AU - Andersen, H U

AU - Damm, P

AU - Mathiesen, E R

PY - 2013/8

Y1 - 2013/8

N2 - Aims: To investigate whether the incidence of severe hypoglycaemia in pregnant women with type 1 diabetes can be reduced without deteriorating HbA1c levels or pregnancy outcomes in a routine care setting. Methods: Two cohorts (2004-2006; n= 108 and 2009-2011; n= 104) were compared. In between the cohorts a focused intervention including education of caregivers and patients in preventing hypoglycaemia was implemented. Women were included at median 8 (range 5-13) weeks. Severe hypoglycaemia (requiring assistance from others) was prospectively reported in structured interviews. Results: In the first vs. second cohort, severe hypoglycaemia during pregnancy occurred in 45% vs. 23%, p= 0.0006, corresponding to incidences of 2.5 vs. 1.6 events/patient-year, p= 0.04. Unconsciousness and/or convulsions occurred at 24% vs. 8% of events. Glucagon and/or glucose injections were given at 15% vs. 5% of events. At inclusion HbA1c was comparable between the cohorts while in the second cohort fewer women reported impaired hypoglycaemia awareness (56% vs. 36%, p= 0.0006), insulin dose in women on multiple daily injections was lower (0.77. IU/kg (0.4-1.7) vs. 0.65 (0.2-1.4), p= 0.0006) and more women were on insulin analogues (rapid-acting 44% vs. 97%, p< 0.0001; long-acting 6% vs. 76%, p< 0.0001) and insulin pumps (5% vs. 23%, p< 0.0001). Pregnancy outcomes were similar in the two cohorts. Conclusions: A 36% reduction in the incidence of severe hypoglycaemia in pregnancy with unchanged HbA1c levels and pregnancy outcomes was observed after implementation of focused intervention against severe hypoglycaemia in a routine care setting. Improved insulin treatment, increased health professional education and fewer women with impaired hypoglycaemia awareness may contribute.

AB - Aims: To investigate whether the incidence of severe hypoglycaemia in pregnant women with type 1 diabetes can be reduced without deteriorating HbA1c levels or pregnancy outcomes in a routine care setting. Methods: Two cohorts (2004-2006; n= 108 and 2009-2011; n= 104) were compared. In between the cohorts a focused intervention including education of caregivers and patients in preventing hypoglycaemia was implemented. Women were included at median 8 (range 5-13) weeks. Severe hypoglycaemia (requiring assistance from others) was prospectively reported in structured interviews. Results: In the first vs. second cohort, severe hypoglycaemia during pregnancy occurred in 45% vs. 23%, p= 0.0006, corresponding to incidences of 2.5 vs. 1.6 events/patient-year, p= 0.04. Unconsciousness and/or convulsions occurred at 24% vs. 8% of events. Glucagon and/or glucose injections were given at 15% vs. 5% of events. At inclusion HbA1c was comparable between the cohorts while in the second cohort fewer women reported impaired hypoglycaemia awareness (56% vs. 36%, p= 0.0006), insulin dose in women on multiple daily injections was lower (0.77. IU/kg (0.4-1.7) vs. 0.65 (0.2-1.4), p= 0.0006) and more women were on insulin analogues (rapid-acting 44% vs. 97%, p< 0.0001; long-acting 6% vs. 76%, p< 0.0001) and insulin pumps (5% vs. 23%, p< 0.0001). Pregnancy outcomes were similar in the two cohorts. Conclusions: A 36% reduction in the incidence of severe hypoglycaemia in pregnancy with unchanged HbA1c levels and pregnancy outcomes was observed after implementation of focused intervention against severe hypoglycaemia in a routine care setting. Improved insulin treatment, increased health professional education and fewer women with impaired hypoglycaemia awareness may contribute.

U2 - 10.1016/j.diabres.2013.06.002

DO - 10.1016/j.diabres.2013.06.002

M3 - Journal article

C2 - 23820486

SN - 0168-8227

VL - 101

SP - 123

EP - 130

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

IS - 2

ER -

The incidence of severe hypoglycaemia in pregnant women with type 1 diabetes mellitus can be reduced with unchanged HbA1c levels and pregnancy outcomes in a routine care setting

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