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Nosova EV, O'Malley G, Dassau E, Levy CJ. Leveraging technology for the treatment of type 1 diabetes in pregnancy: A review of past, current, and future therapeutic tools. J Diabetes 2020; 12:714-732. [PMID: 32125763 DOI: 10.1111/1753-0407.13030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 12/16/2022] Open
Abstract
The significant risks associated with pregnancies complicated by type 1 diabetes (T1D) were first recognized in the medical literature in the mid-twentieth century. Stringent glycemic control with hemoglobin A1c (HbA1c) values ideally less than 6% has been shown to improve maternal and fetal outcomes. The management options for pregnant women with T1D in the modern era include a variety of technologies to support self-care. Although self-monitoring of blood glucose (SMBG) and multiple daily injections (MDI) are often the recommended management options during pregnancy, many people with T1D utilize a variety of different technologies, including continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (CSII), and CSII including automated delivery or suspension algorithms. These systems have yielded invaluable diagnostic and therapeutic capabilities and have the potential to benefit this understudied higher-risk group. A recent prospective, multicenter study evaluating pregnant patients with T1D revealed that CGM significantly improves maternal glycemic parameters, is associated with fewer adverse neonatal outcomes, and minimizes burden. Outcome data for CSII, which is approved for use in pregnancy and has been utilized for several decades, remain mixed. Current evidence, although limited, for commercially available and emerging technologies for the management of T1D in pregnancy holds promise for improving patient and fetal outcomes.
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Affiliation(s)
- Emily V Nosova
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Grenye O'Malley
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Carol J Levy
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Chen X, Wang D, Lin J, Zhang T, Deng S, Huang L, Jin Y, Chen C, Zhang Z, Zheng J, Sun B, Bogdan P, Zhang XD. Analyzing Complexity and Fractality of Glucose Dynamics in a Pregnant Woman with Type 2 Diabetes under Treatment. Int J Biol Sci 2019; 15:2373-2380. [PMID: 31595155 PMCID: PMC6775315 DOI: 10.7150/ijbs.33825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/27/2019] [Indexed: 11/05/2022] Open
Abstract
Currently, the rapid development of continuous glucose monitoring (CGM) device brings new insights into the treatment of diabetic patients including those during pregnancy. Complexity and fractality have recently under fast development for extracting information embodied in glucose dynamics measured using CGM. Although scientists have investigated the difference of complexity in glucose dynamics between diabetes and non-diabetes in order to discover better approaches for diabetes care, no one has analyzed the complexity and fractality of glucose dynamics during the process of adopting CGM to successfully treat pregnant women with type 2 diabetes. Thus, we analyzed the complexity and fractality using power spectral density (PSD), multi-scale sample entropy (MSE) and multifractal detrended fluctuation analysis (MF-DFA) in a clinical case. Our results show that (i) there exists multifractal behavior in blood glucose dynamics; (ii) the alpha stable distribution fits to the glucose increment data better than the Gaussian distribution; and (iii) the "global" complexity indicated by multiscale entropy, spectrum exponent and Hurst exponent increase and the "local" complexity indicated by multifractal spectrum decrease after the successful therapy. Our results offer findings that may bring value to health care providers for managing glucose levels of pregnant women with type 2 diabetes as well as provide scientists a reference on applying complexity and fractality in the clinical practice of treating diabetes.
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Affiliation(s)
- Xiaoyan Chen
- Department of Endocrinology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
| | - Dandan Wang
- Faculty of Health Sciences, University of Macau, Taipa 999078, Macau
| | - Jinxiang Lin
- Department of Endocrinology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
| | - Teng Zhang
- Faculty of Health Sciences, University of Macau, Taipa 999078, Macau
| | - Shunyou Deng
- Department of Endocrinology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
| | - Lianyi Huang
- Department of Endocrinology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
| | - Yu Jin
- Faculty of Health Sciences, University of Macau, Taipa 999078, Macau
| | - Chang Chen
- Faculty of Health Sciences, University of Macau, Taipa 999078, Macau
| | - Zhaozhi Zhang
- Department of Statistical Science, Duke University, Durham, NC 27708, USA
| | - Jun Zheng
- Faculty of Health Sciences, University of Macau, Taipa 999078, Macau
| | - Baoqing Sun
- Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Diseases, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
| | - Paul Bogdan
- Department of Electrical Engineering - Systems, University of Southern California, CA 90089, USA
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Bradley PK, Duprey M, Castorino K. Identifying Key Intervention Opportunities During a Pregnancy Complicated by Diabetes: a Review of Acute Complications of Diabetes During Pregnancy. Curr Diab Rep 2016; 16:17. [PMID: 26810312 DOI: 10.1007/s11892-015-0710-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diabetes in pregnancy is associated with significant and sometimes devastating acute complications. It is important that all health care providers are aware of possible complications at each stage of pregnancy so that we can prevent these complications whenever possible and reduce morbidity when they do occur. Most complications associated with diabetes during pregnancy have reduced incidence when blood glucose and blood pressure are optimally controlled. Yet, it is always best to try to optimize diabetes and any comorbidities prior to conception.
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Affiliation(s)
- Paige K Bradley
- William Sansum Diabetes Center, 2219 Bath St., Santa Barbara, CA, 93105, USA.
| | - Marissa Duprey
- William Sansum Diabetes Center, 2219 Bath St., Santa Barbara, CA, 93105, USA.
| | - Kristin Castorino
- William Sansum Diabetes Center, 2219 Bath St., Santa Barbara, CA, 93105, USA.
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Barbour LA. Changing perspectives in pre-existing diabetes and obesity in pregnancy: maternal and infant short- and long-term outcomes. Curr Opin Endocrinol Diabetes Obes 2014; 21:257-63. [PMID: 24937039 DOI: 10.1097/med.0000000000000079] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Climbing obesity rates in women have propelled the increasing prevalence of type 2 diabetes mellitus (T2DM) in pregnancy, and an increasing number of women with type 1 diabetes mellitus (T1DM) are also affected by obesity. Increasing recognition that an intrauterine environment characterized by obesity, insulin resistance, nutrient excess, and diabetes may be fueling the obesity epidemic in children has created enormous pressure to re-examine the conventional wisdom of our current approaches. RECENT FINDINGS Compelling data in pregnancies complicated by diabetes, in particular those accompanied by insulin resistance and obesity, support a fetal programming effect resulting in increased susceptibility to metabolic disease for the offspring later in life. Recent data also underscore the contribution of obesity, lipids, and lesser degrees of hyperglycemia on fetal fat accretion, challenging the wisdom of current gestational weight gain recommendations with and without diabetes. The risks of adverse pregnancy outcomes in T2DM are at least as high as in T1DM and there remains controversy about the ideal glucose treatment targets, the benefit of different insulin analogues, and the role of continuous glucose monitoring in T1DM and T2DM. SUMMARY It has become unmistakably evident that achieving optimal outcomes in mothers with diabetes is clearly impacted by ideal glycemic control but goes far beyond it. The intrauterine metabolic environment seems to have long-term implications on the future health of the offspring so that the effectiveness of our current approaches can no longer be simply measured by whether or not maternal glucose values are at goal.
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Affiliation(s)
- Linda A Barbour
- Divisions of Endocrinology, Metabolism and Diabetes and Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Mello G, Biagioni S, Ottanelli S, Nardini C, Tredici Z, Serena C, Marchi L, Mecacci F. Continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) of rapid-acting insulin analogues and detemir in type 1 diabetic (T1D) pregnant women. J Matern Fetal Neonatal Med 2014; 28:276-80. [DOI: 10.3109/14767058.2014.914922] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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In reply. Obstet Gynecol 2014; 123:1106-1107. [PMID: 24785866 DOI: 10.1097/aog.0000000000000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mathiesen JM, Secher AL, Ringholm L, Nørgaard K, Hommel E, Andersen HU, Damm P, Mathiesen ER. Changes in basal rates and bolus calculator settings in insulin pumps during pregnancy in women with type 1 diabetes. J Matern Fetal Neonatal Med 2013; 27:724-8. [DOI: 10.3109/14767058.2013.837444] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Garcia-Vargas L, Addison SS, Nistala R, Kurukulasuriya D, Sowers JR. Gestational Diabetes and the Offspring: Implications in the Development of the Cardiorenal Metabolic Syndrome in Offspring. Cardiorenal Med 2012; 2:134-142. [PMID: 22851962 DOI: 10.1159/000337734] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The risk of developing type 2 diabetes and cardiovascular disease in women who had previously been diagnosed with gestational diabetes (GDM) is well established. There is increasing evidence that the offspring of women with GDM are at increased risk for the development of all components of the cardiorenal metabolic syndrome. Overall, it appears that these offspring have an increased risk for overweight/obesity, insulin resistance, higher blood pressure, renal disease, and type 2 diabetes. However, distinct differences in regional populations, lack of routine screening and treatment of GDM worldwide, and long follow-up periods for offspring represent a challenge in assessing the risk for development of these abnormalities in the offspring of women who have had GDM.
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Affiliation(s)
- Liliana Garcia-Vargas
- Division of Endocrinology, Department of Internal Medicine, University of Missouri-Columbia, Columbia, Mo., USA
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