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C-peptide concentration in pregnant women with Type 1 Diabetes Mellitus and prevalence of severe hypoglycemia

The effort to reach the ideal glycemic control in type 1 diabetic pregnancy (T1DM) is often linked with increased risk of hypoglycemia. The aim of the study was to find the effect of C- peptide concentration on severe hypoglycemia prevalence in diabetic pregnancy and its impact on insulin doses and fetal macrosomia. Study participants. 90 women with T1DM and singleton pregnancy, who received insulin treatment for ≥ 24 months, were included in the study. The HbA1c was ≤ 8% at pregnancy confirmation. The study was conducted in Department of Obstetrics and Gynecology, School of Medicine University of Zagreb, as a part of scientific project PRE-HYPO No IP-2018-01-1284. Participants were divided into three groups according to duration of diabetes: 1. group 2-10 years (n=36) ; 2. group 11-20 years (n=36), and 3. group ≥ 20 years (n=18). Severe hypoglycemia was defined as glucose concentration below 3 mmol / L. Results. The percentage of severe hypoglycemia in the first trimester according the groups was 41.7%, 66.7% and 77.8%, respectively, and it declined in third trimester in all three groups (19.4% ; 38.9% and 66.7%, respectively). The C- peptide concentration in group 1 was significantly higher throughout pregnancy when compared with group 2 and 3 (P=0.011 ; P=0.015 ; P <0.001). The negative correlation (Spearman) was found between C-peptide concentration and both bolus and basal insulin dose (rs = -0.402, P = 0.012 ; rs = - 0.412 ; P = 0.012 respectively). The negative correlation was between HbA1c and C- peptide concentration (rs = -0.765 ; P = 0.001). There was significant correlation between HbA1c and neonatal weight (r = 0.358 ; P= 0.001). Conclusion. Higher C-peptide concentration was found in pregnant patients with shorter duration of diabetes. Lower prevalence of hypoglycemia and lower bolus-basal doses were required in T1DM women who had pregnancy mediated increased endogenous insulin secretion.

Type 1 diabetes mellitus ; hypoglycemia ; pregnancy ; C-peptide

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