Advances in pharmacological treatment of type 1 diabetes during pregnancy

ABSTRACT

Introduction: In women with type 1 diabetes mellitus (T1DM), pregnancy is associated with a potential risk of maternal, foetal and neonatal outcomes. Stringent metabolic control is required to improve these outcomes.

Areas covered: In this review, the authors summarise the current evidence from studies on the pharmacological therapy and on monitoring of T1DM during pregnancy. The authors also discuss the use of new technologies to improve therapeutic management and patient compliance.

Expert opinion: Pre-conception counselling is essential in T1DM to minimise pregnancy risks. Pregnancy in T1DM is always considered a high-risk pregnancy. During pregnancy, the target haemoglobin A1C (HbA_1c) is near-normal at <6%, without excessive hypoglycaemia. Strict control of pre- and post-prandial glucose is also required. Human soluble insulin, neutral protamine Hagedorn and the quick-acting insulin analogues aspart and lispro are widely used. Insulin is administered either as a basal-bolus regimen or by continuous subcutaneous insulin infusion. Careful and strict glucose monitoring is also needed during labour and delivery, including caesarean section. Moreover, the control of retinopathy, hypertension, nephropathy, hyper- and hypothyroidism is required. Post-partum, insulin requirements decrease, and less stringent glycaemic control is pursued, to avoid hypoglycaemias. Finally, breastfeeding is recommended and should be encouraged.

KEYWORDS:

• Diabetic complications
• glycaemic control
• pregnancy
• type 1 diabetes mellitus

ARTICLE HIGHLIGHTS

• Type 1 Diabetes Mellitus is becoming increasingly common and may affect women of childbearing age.

• Inadequate glycaemic control during pregnancy may result in significant morbidity and mortality for mother and neonate.

• During pregnancy, lower glucose and glycated haemoglobin targets are sought.

• Basal bolus insulin therapy or insulin pump therapy are used. Several insulin analogues are now approved during pregnancy.

• Early and effective screening for and management of comorbidities and diabetic complications are needed.

• Patient education and nutrition advice are very useful.

• Technological tools in the therapeutic management of diabetes during pregnancy are important for reduction of hypoglycemia risk and the improvement of the quality of life.

This box summarizes key points contained in the article.

Declaration of interest

M Rizzo has received grants and/or fees from Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Meda Pharmaceuticals, Merck & Co, Novo Nordisk, Roche and Servier. N Papanas has been an advisory board member of TrigoCare International, Abbott, AstraZeneca, Elpen, Merck Sharp and Dohme, Novartis, Novo Nordisk, Sanofi and Takeda and has participated in sponsored studies by Eli Lilly and Company, Merck Sharp and Dohme, Novo Nordisk, Novartis and Sanofi. He has also received speaker’s honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Elpen, Galenica, Merck Sharp and Dohme, Mylan, Novartis, Novo Nordisk, Pfizer, Sanofi, Takeda and Vianex and attended conferences sponsored by TrigoCare International, AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Novartis, Novo Nordisk, Pfizer and Sanofi. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.