Benefits, risks, costs, and patient satisfaction associated with insulin pump therapy for the pregnancy complicated by type 1 diabetes mellitus

OBJECTIVE: Glycemic control, perinatal outcome, and health care costs were evaluated among women with type 1 diabetes mellitus who began insulin pump therapy during pregnancy (group 1, n = 24), were treated with multiple insu lin injections (group 2, n = 24), or were already using an insulin pump bef ore pregnancy (group 3, n = 12). Patient satisfaction and continuation of p ump therapy post partum were assessed. STUDY DESIGN: A retrospective review of maternal and neonatal medical recor ds was performed, and a questionnaire was sent to patients after delivery. Patients in groups 1 and 2 were matched for age, age at onset and duration of diabetes mellitus, White class, and date of delivery. RESULTS: No differences in glycosylated hemoglobin A levels were observed a mong groups 1, 2 or 3 in the first, second, or third trimester. Patients in group 1 started pump therapy at a mean of 16.8 weeks' gestation, and 17 (7 0.8%) began therapy as outpatients. No deterioration in glycemic control wa s noted during the 2- to 4-week period after the start of pump treatment. A mong the women in group 1 eight had at least one episode of severe hypoglyc emia before starting pump therapy, but only one had such an episode after t his treatment was begun. Two episodes of ketoacidosis occurred in group 1, and no episodes occurred in groups 2 and 3. No significant differences in p erinatal outcomes or health care costs were observed among groups 1, 2, and 3. After delivery 94.7% of the women in group 1 continued to use the pump because it provided better glycemic control and a more flexible lifestyle. Postpartum glycosylated hemoglobin A values were 7.2% in group 1 and 9.1% i n group 2, a significant difference. CONCLUSIONS: Insulin pump therapy was initiated during pregnancy without a deterioration of glycemic control and was associated with maternal and peri natal outcomes and health care costs comparable to those among women who we re already using the pump before pregnancy or who received multiple-dose in sulin therapy. Women who began pump therapy in pregnancy were highly likely to continue pump use after delivery and preferred the flexible lifestyle t hat this treatment allowed.