Use of insulin pumps in pregnancies complicated by type 2 diabetes and gestational diabetes in a multiethnic community

OBJECTIVE - To describe the use of insulin pump therapy in women with gesta tional diabetes mellitus (GDM) or type 2 diabetes in pregnancy and persiste nt hyperglycemia despite multiple injections of subcutaneous insulin. RESEARCH DESIGN AND METHODS - As part of a service audit, deliveries to wom en with diabetes at a single South Auckland hospital were reviewed from 199 1 through 1994. Glycemic control was estimated by the mean of self-recorded and laboratory postprandial glucose concentrations. In a nested case-contr ol study, pregnancies complicated by GDM/type 2 diabetes with use of an ins ulin pump were compared with those without insulin pump therapy and peak in sulin requirements of 100-199 units/day, matched for ethnicity and type of diabetes. RESULTS - A total of 30 of 251 Polynesian, European, and South Asian women with singleton pregnancies complicated by insulin-requiring GDM/type 2 diab etes used an insulin pump. An additional two women with high insulin requir ements discontinued pump therapy. None of the women with GDM/type 2 diabete s experienced severe hypoglycemia, whereas 79% of the women had improved gl ycemic control within 1-4 weeks. Mothers using a pump had greater insulin r equirements (median maximum 246 vs. 130 units per day) and greater weight g ain (10.6 vs. 5.0 kg). Their babies were more likely to be admitted to the Special Care Baby Unit but were neither significantly heavier nor experienc ed greater hypoglycemia than control subjects. CONCLUSIONS - Insulin pump therapy seems to be safe and effective for maint aining glycemic control in pregnancies complicated by GDM/type 2 diabetes a nd requiring large doses of insulin.