Affiliation:
1. Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diabetology, Sun Yat-Sen University , Guangzhou 510630 , China
2. Department of Endocrinology, Institute of Endocrine and Metabolic Disease, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Clinical Research Hospital of Chinese Academy of Sciences (Hefei), University of Science and Technology of China , Hefei 230001 , China
Abstract
Abstract
Objectives
To evaluate the relative contribution of basal hyperglycemia (BHG) and postprandial hyperglycemia (PHG) to the time in range (TIR) categories and adverse pregnancy outcomes in pregnant women with type 1 diabetes mellitus (T1DM).
Materials and Methods
This observational study included 112 pregnancies with T1DM from the CARNATION study who wore continuous glucose monitoring (CGM) devices during pregnancy. The data from CGM were analyzed for TIR (range, 3.5-7.8 mmol/L), areas under the curve of PHG, area under the curve of BHG, and BHG and PHG contribution rates. The contribution rates of BHG and PHG to the different levels of TIR (<60%, 60-78%, ≥78%) and adverse pregnancy outcomes were analyzed.
Results
The participants’ average age was 28.8 ± 3.9 years with a diabetes duration of 8.4 ± 6.2 years. All women experienced a mean TIR of 75.6 ± 19.0% and a mean glycated hemoglobin of 6.2 ± 1.1% during pregnancy. The BHG contribution accounted for 74.9% (36.8, 100), 69.2% (13.4, 100), and 66.5% (10.0, 100) (P < .001) and PHG accounted for 25.1% (0, 63.2), 30.8% (0, 86.6), and 33.5% (0, 90.0) (P < .001) when participants experienced the TIR<60%, 60%-78%, and ≥78%, respectively. Participants with higher BHG contribution rates tended to have more adverse pregnancy outcomes.
Conclusion
Basal hyperglycemia was the major contributor to TIR during pregnancy. Along with controlling PHG, pregnant women with T1DM who did not reach the target of TIR may benefit more from the optimization of insulin regimens focusing on reducing basal glucose.