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Type 1 diabetes mellitus (T1DM) may be managed with continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI), however comparisons of insulin profiles between these two modalities have not been well described. Our objective was to characterize and compare the changes in insulin basal and bolus dosing across gestation in patients managed with CSII and MDI.
This retrospective cohort examined women with T1DM with first trimester HbA1c < 7.4. The primary outcome was a comparison of changes in basal and bolus insulin between CSII and MDI from preconception (PC) to delivery.
Five patients managed with CSII and five patients with MDI were compared. There were no differences in maternal age (30±1.3 vs. 28±6.2 years, p=0.38), PC BMI (23.9±3.3 vs. 24.7±1.8 kg/m2, p=0.67), PC hemoglobin A1C (6.2±0.40 vs. 6.7±0.7%, p=0.38) or third trimester A1C (5.7±3.6 vs. 6.1±0.6, p=0.25). Increases in basal and bolus insulin across gestation were noted for both CSII and MDI patients with a peak at 32 weeks (Figure). There were no statistical differences at any gestational age in total and bolus insulin doses among those managed with CSII versus MDI. A higher basal insulin rate was required across gestation in the MDI group when compared with the CSII group but this difference only reached statistical significance at 20 weeks (Figure). Among the CSII group, the percent change in basal insulin from PC to peak insulin requirement was 10%, while the percent change in bolus insulin was 134%. In the MDI cohort, the corresponding percent change in basal insulin was 57% and in bolus insulin was 152%.
In patients with well-controlled T1DM, there are differences in insulin dosing among those managed with CSII and MDI. There was a higher increase in basal insulin requirements in those managed by MDI when compared to those on CSII. These data may improve insulin management in T1DM pregnancies.