Pregnancy and Diabetes: What Matters Most?
Pregnancy and Diabetes: What Matters Most?
Editor's Note:
The following is an edited transcript of a conversation between 2 diabetes experts at the recent annual meeting of the European Association for the Study of Diabetes (EASD).
Leszek Czupryniak, MD, PhD: Hello. My name is Leszek Czupryniak, and my guest is Dr. Maciej Malecki from Poland. He is a professor of endocrinology and diabetes in one of the most important centers in that country. He is here to share with us the latest research on pregnancy issues in diabetes.
Maciej T. Malecki, MD, PhD: At this meeting, we have seen new data on diagnosis, screening, monitoring, and treating diabetes during pregnancy. I was particularly impressed with the Irish study that looked at whether screening for gestational diabetes should be universal or selective. The answer is universal rather than selective.
Dr. Czupryniak: Because we miss too many patients when we are selective?
Dr. Malecki: Yes. We miss too many patients if we decide to be selective. I think the message is that this screening should be universal. There was not much discussion about screening criteria, such as those derived from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study. I think this is good, because we should be moving from the discussion phase to the implementation phase, rather than focusing on whether to use this or that criterion.
Dr. Czupryniak: So, all pregnant women should be screened for gestational diabetes, and the HAPO criteria, which use the lower threshold values of blood glucose to diagnose diabetes, seem to be acceptable?
Dr. Malecki: It appears so, yes.
The other important message, I would say, is the importance of pregnancy planning in type 1 diabetes. I would point to another Irish study presented here that showed that pregnancy planning had an enormous impact on the woman's glycemic control during pregnancy. It also -- and this is even more important -- had a significant impact on outcomes, both neonatal and maternal. So the message is that we should encourage our patients with type 1 diabetes to plan their pregnancy and to participate in an educational program.
Dr. Czupryniak: It has been recommended, of course, that patients with type 1 diabetes should plan their pregnancies, but what we've learned here in Berlin reinforces how important it is for us to explain this to patients.
Any news on treatment?
Dr. Malecki: There was a very interesting French presentation that showed very good results with insulin pumps in patients with type 1 diabetes. They were able to achieve excellent glycemic levels, and I definitely think we should consider this treatment method in our patients with type 1 diabetes who become pregnant. We also presented our data from Krakow in which we were also able to achieve excellent glycemic control using insulin pumps. But again, I would like to emphasize that the most important factor still is pregnancy planning.
Dr. Czupryniak: Yes, because that allows patients to achieve the best glucose control at the early stage of the pregnancy, which is the most vital part of the pregnancy.
Dr. Malecki: Exactly.
Dr. Czupryniak: What about pregnancy in patients with type 2 diabetes? This has not been well studied because there were not as many of these patients, but my impression is that the number is growing, and we will face this challenge much more often in the near future.
Dr. Malecki: You are correct. The number is growing and will continue to grow with the epidemic of type 2 diabetes. There was a meta-analysis published a few years ago that compared the glycemic control and outcomes in pregnant women with type 1 diabetes and in pregnant women with type 2 diabetes. Despite better glycemic control, the women with type 2 diabetes did not achieve better outcomes compared with those who had type 1 diabetes.
Dr. Czupryniak: It sounds like type 2 diabetes is a dangerous condition when combined with pregnancy.
Dr. Malecki: Yes, and the study presented here confirmed this conclusion. Again, despite very reasonable glycemic control, many of the pregnant women with type 2 diabetes had adverse outcomes, both in mothers and in newborns.
Now, before we end this conversation, I would like to mention another study we presented here on a new marker of glycemic control in pregnancy complicated by type 1 diabetes. We studied 1.5-anhydroglucitol, and this marker very nicely correlated with the gold standard of glycemic control, a continuous glucose monitoring system (CGMS). It also was a wonderful predictor of macrosomia in patients with type 1 diabetes.
Dr. Czupryniak: That's interesting.
Dr. Malecki: We still are lacking an ideal glycemic control marker in type 1 diabetes; A1c is certainly not the one. CGMS is expensive and time-consuming, so I think there may be room for a new biomarker of glycemic control. Now that enzyme-linked immunosorbent assay (ELISA) kits are available, this test is much easier and cheaper.
Editor's Note:
The following is an edited transcript of a conversation between 2 diabetes experts at the recent annual meeting of the European Association for the Study of Diabetes (EASD).
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Leszek Czupryniak, MD, PhD |
Leszek Czupryniak, MD, PhD: Hello. My name is Leszek Czupryniak, and my guest is Dr. Maciej Malecki from Poland. He is a professor of endocrinology and diabetes in one of the most important centers in that country. He is here to share with us the latest research on pregnancy issues in diabetes.
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|
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Maciej T. Malecki, MD, PhD |
Maciej T. Malecki, MD, PhD: At this meeting, we have seen new data on diagnosis, screening, monitoring, and treating diabetes during pregnancy. I was particularly impressed with the Irish study that looked at whether screening for gestational diabetes should be universal or selective. The answer is universal rather than selective.
Dr. Czupryniak: Because we miss too many patients when we are selective?
Dr. Malecki: Yes. We miss too many patients if we decide to be selective. I think the message is that this screening should be universal. There was not much discussion about screening criteria, such as those derived from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study. I think this is good, because we should be moving from the discussion phase to the implementation phase, rather than focusing on whether to use this or that criterion.
Dr. Czupryniak: So, all pregnant women should be screened for gestational diabetes, and the HAPO criteria, which use the lower threshold values of blood glucose to diagnose diabetes, seem to be acceptable?
Dr. Malecki: It appears so, yes.
The other important message, I would say, is the importance of pregnancy planning in type 1 diabetes. I would point to another Irish study presented here that showed that pregnancy planning had an enormous impact on the woman's glycemic control during pregnancy. It also -- and this is even more important -- had a significant impact on outcomes, both neonatal and maternal. So the message is that we should encourage our patients with type 1 diabetes to plan their pregnancy and to participate in an educational program.
Dr. Czupryniak: It has been recommended, of course, that patients with type 1 diabetes should plan their pregnancies, but what we've learned here in Berlin reinforces how important it is for us to explain this to patients.
Any news on treatment?
Dr. Malecki: There was a very interesting French presentation that showed very good results with insulin pumps in patients with type 1 diabetes. They were able to achieve excellent glycemic levels, and I definitely think we should consider this treatment method in our patients with type 1 diabetes who become pregnant. We also presented our data from Krakow in which we were also able to achieve excellent glycemic control using insulin pumps. But again, I would like to emphasize that the most important factor still is pregnancy planning.
Dr. Czupryniak: Yes, because that allows patients to achieve the best glucose control at the early stage of the pregnancy, which is the most vital part of the pregnancy.
Dr. Malecki: Exactly.
Dr. Czupryniak: What about pregnancy in patients with type 2 diabetes? This has not been well studied because there were not as many of these patients, but my impression is that the number is growing, and we will face this challenge much more often in the near future.
Dr. Malecki: You are correct. The number is growing and will continue to grow with the epidemic of type 2 diabetes. There was a meta-analysis published a few years ago that compared the glycemic control and outcomes in pregnant women with type 1 diabetes and in pregnant women with type 2 diabetes. Despite better glycemic control, the women with type 2 diabetes did not achieve better outcomes compared with those who had type 1 diabetes.
Dr. Czupryniak: It sounds like type 2 diabetes is a dangerous condition when combined with pregnancy.
Dr. Malecki: Yes, and the study presented here confirmed this conclusion. Again, despite very reasonable glycemic control, many of the pregnant women with type 2 diabetes had adverse outcomes, both in mothers and in newborns.
Now, before we end this conversation, I would like to mention another study we presented here on a new marker of glycemic control in pregnancy complicated by type 1 diabetes. We studied 1.5-anhydroglucitol, and this marker very nicely correlated with the gold standard of glycemic control, a continuous glucose monitoring system (CGMS). It also was a wonderful predictor of macrosomia in patients with type 1 diabetes.
Dr. Czupryniak: That's interesting.
Dr. Malecki: We still are lacking an ideal glycemic control marker in type 1 diabetes; A1c is certainly not the one. CGMS is expensive and time-consuming, so I think there may be room for a new biomarker of glycemic control. Now that enzyme-linked immunosorbent assay (ELISA) kits are available, this test is much easier and cheaper.