The functional status of the kidneys in pregnant women with diabetes mellitus (type 1) when using continuous subcutaneous insulin infusion and continuous monitoring of blood glucose levels

Tisel’ko A.V.; Yarmolinskaya M.I.; Borovik N.V.; Suslova S.V.; Misharina E.V.; Milutina Yu.P.

doi:https://doi.org/10.17116/rosakush20202006156

Tisel’ko A.V.

Ott Scientific Research Institute of Obstetrics, Gynecology and Reproductology

Yarmolinskaya M.I.

D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology;
I.I. Mechnikov North-Western State Medical University

ORCID: 0000-0002-6551-4147

Borovik N.V.

Ott Scientific Research Institute of Obstetrics, Gynecology and Reproductology

Suslova S.V.

Ott Scientific Research Institute of Obstetrics, Gynecology and Reproductology

Misharina E.V.

Ott Scientific Research Institute of Obstetrics, Gynecology and Reproductology

SPIN RSCI: 7350-5674
Scopus AuthorID: 57200069538
ORCID: 0000-0002-0276-7112

Milutina Yu.P.

Ott Scientific Research Institute of Obstetrics, Gynecology and Reproductology

The functional status of the kidneys in pregnant women with diabetes mellitus (type 1) when using continuous subcutaneous insulin infusion and continuous monitoring of blood glucose levels

Authors:

Tisel’ko A.V., Yarmolinskaya M.I., Borovik N.V., Suslova S.V., Misharina E.V., Milutina Yu.P.

More about the authors

Journal: Russian Bulletin of Obstetrician-Gynecologist. 2020;20(6): 56‑64

DOI: 10.17116/rosakush20202006156

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To cite this article:

Tisel’ko AV, Yarmolinskaya MI, Borovik NV, Suslova SV, Misharina EV, Milutina YuP. The functional status of the kidneys in pregnant women with diabetes mellitus (type 1) when using continuous subcutaneous insulin infusion and continuous monitoring of blood glucose levels. Russian Bulletin of Obstetrician-Gynecologist. 2020;20(6):56‑64. (In Russ.)
https://doi.org/10.17116/rosakush20202006156

Подписка 2026 Российский вестник акушера-гинеколога (Russian Bulletin of Obstetrician-Gynecologist)

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OBJECTIVE

To study the glycemic profile and functional status of the kidneys during pregnancy in women with type I diabetes (with or without diabetic nephropathy — DN — before pregnancy), using continuous subcutaneous insulin infusion (CSII) and multiple insulin injections (MII).

MATERIAL AND METHODS

Continuous monitoring of glucose level (CMGL) in the blood, assessment of the glomerular filtration rate, the severity of proteinuria, the incidence and severity of preeclampsia, arterial hypertension in 100 pregnant women with type I diabetes who used CSII and in 100 patients who received multiple insulin injections were performed.

RESULTS

As a result of the work, it was found that the level of glycated hemoglobin A1c (HbA1c) in the III trimester in pregnant women with DN, chronic kidney disease — C2 A2-3 was higher when using the MII regimen in comparison with pregnant women with similar kidney damage when using the CSII regimen. A negative correlation was found between various indicators of variability in blood glucose concentration and glomerular filtration rate (GFR). In the group of patients who used MII, the correlation coefficient of glucose levels fluctuations amplitude — the MAGE index and GFR was r= –0.32 (p<0.01), the coefficient of pathological variability duration of blood glucose concentration — the MODD index and GFR was r= –0.28 (p<0.01). The correlation coefficient of hyperglycemia duration for the entire period of CMGL (% of time) and GFR was r= –0.30 (p<0.01). The maximum variability in blood glucose concentration according to the results of the MAGE index was in the group of patients with severe DN before pregnancy and was statistically significantly different from the corresponding indicator in the control group and in the group of patients without DN. It was revealed that the daily protein loss (DPL) in the group of women with DN, GFR C2 A2-3 and concomitant preeclampsia when using the CSII regimen was 0.00 [0.00—0.42] g /l and was less (p<0/01) than in the group of women who used MII (0.24 [0.07—0.50] g/l).

CONCLUSION

The CMGL usage to assess the glycemic profile has revealed a relationship between the pathological variability of blood glucose levels and the severity of DN and preeclampsia and confirmed the advantages of using CSII in pregnant women with type I diabetes in achieving target blood glucose levels, reducing the variability of blood glucose concentration, duration of hypertension and hypoglycemic episodes, which contributed to reduction of preeclampsia incidence, the level of proteinuria and arterial hypertension.

Keywords:

type I diabetes mellitus

pregnancy

continuous subcutaneous insulin infusion

continuous monitoring of blood glucose levels

and variability in glucose concentration

diabetic nephropathy

and preeclampsia

Authors:

Tisel’ko A.V.

Ott Scientific Research Institute of Obstetrics, Gynecology and Reproductology

Yarmolinskaya M.I.

D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology;
I.I. Mechnikov North-Western State Medical University

ORCID: 0000-0002-6551-4147

Borovik N.V.

Ott Scientific Research Institute of Obstetrics, Gynecology and Reproductology

Suslova S.V.

Ott Scientific Research Institute of Obstetrics, Gynecology and Reproductology

Misharina E.V.

Ott Scientific Research Institute of Obstetrics, Gynecology and Reproductology

SPIN RSCI: 7350-5674
Scopus AuthorID: 57200069538
ORCID: 0000-0002-0276-7112

Milutina Yu.P.

Ott Scientific Research Institute of Obstetrics, Gynecology and Reproductology

Received:

16.03.2020

Accepted:

05.06.2020

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