Availability of technology assisting antenatal glycemic control in maternal Type 1 diabetes has increased over the last 5 years; due to Australia’s national diabetes support scheme (ndss) funding continuous glucose monitoring (CGM)/flash sensor since March 2019. A need for frequent adjustments to insulin therapy in pregnancy are commonplace. We sought to examine if mode of insulin delivery; multiple daily injection(MDI) or insulin pump(CSII) differ in demand on clinical resources.
Aims:
In a Melbourne public antenatal diabetes clinic, we sought to determine:
(i) the proportion of patients using CGM/Flash sensor, MDI and CSII
(ii) the number of antenatal appointments, for glycemia review, according to method of insulin delivery
Method: This is a retrospective review of patients with pre-existing T1DM, who received antenatal care at Mercy hospital for Women, over 4 consecutive years, January 2018-December 2021. Data included glucose monitoring, mode of insulin delivery, total number of clinic appointments, and gestation at each appointment. Only appointments from CDE and/or diabetes physician/registrar for glycemic control were counted . Pre-pregnancy, pregnancy loss <16 weeks, postpartum appointments and patients transferred for delivery only were excluded. Data is expressed as mean(sd).
Results:
A total of 89 patients (41 MDI, 48 CSII). Mean gestation at delivery was 36 (1.8) weeks, (range 30 to 38weeks). 3 patients commenced CSII in pregnancy. Pre and post ndss subsidy, 56% vs 100% of patients used cgm/flash sensor. Approximately half of patients used CSII (Table 1). The overall number of glycemic appointments per pregnancy, was 14.2(4.5) and did not differ between MDI vs CSII 13.8(4.1) vs 14.1(4.6) respectively, p = 0.7). The glycemic appointments range per pregnancy 2 - 24.
Table 1: CGM/Libre sensor use and mode of Insulin delivery during pregnancy
|
|
2018 |
2019 |
2020 |
2021 |
|
Total patients |
16 |
19 |
24 |
30 |
|
Use of CGM/flash sensor n (%) |
9 (56%) |
17 (89%) |
22 (92%) |
30 (100%) |
|
MDI |
8 |
9 |
12 |
12 |
|
CSII n (%) |
8 (50%) |
10 (53%) |
12 (50%) |
18 (60%) |
Table 2: Number of glycemic reviews per pregnancy according to mode of insulin delivery
|
|
MDI |
CSII |
P Value |
|
2018 |
11.8 (3.6) |
12.5 (4.0) |
|
|
2019 |
13.0 (4.5) |
15.1 (6.2) |
|
|
2020 |
15.0 (5.2) |
14.8 (6.4) |
|
|
2021 |
14.4 (2.2) |
14.9 (3.1) |
|
|
|
|
|
|
|
Overall |
13.8 (4.1) |
14.1 (4.6) |
0.74 (ns) |
Conclusion:
The uptake of CGM/flash sensor use since ndss subsidy for pregnancy increased. Pregnancy is an intense period for glycemic review, with average 14 visits per pregnancy, with no difference between MDI or CSII.