Preconceptional diabetes control in insulin-dependent diabetes mellitus patients with continuous subcutaneous insulin infusion therapy

Programs for maintaining glucose levels strictly within normal ranges have improved the outcome of pregnancies complicated by diabetes mellitus [4,10,11]. The diabetic pregnancy continues to present a significant risk for congenital malformations and neonatal morbidity [3, 14, 15, 20, 21]. It seems that further improvement in the outcome of these pregnancies may be obtained if normal glucose levels are accomplished before conception, to reduce the incidence of congenital malformations [5, 15, 22] and throughout the pregnancy to lower the incidence of macrosomia [3, 23]. This may be achieved with conventional two-dose or multiple insulin injections. Recently, continuous subcutaneous insulin infusion devices have been introduced to improve diabetic control in both the nonpregnant and pregnant diabetic patient [8, 18, 24]. The value of these insulin pumps must be critically assessed. Furthermore collaborative efforts of the diabetology team (diabetologist, dietitian, obstetrician, psychologist, social worker and nurse), as well as the patient, through self blood glucose monitoring (SBGM) is mandatory.