دانلود رایگان مقاله انگلیسی فناوری های اضطراری برای مدیریت دیابت نوع 1 در بارداری - اشپرینگر 2018

Abstract

Purpose of Review The purpose of the study is to discuss emerging technologies available in the management of type 1 diabetes in pregnancy. Recent Findings The latest evidence suggests that continuous glucose monitoring (CGM) should be offered to all women on intensive insulin therapy in early pregnancy. Studies have additionally demonstrated the ability of CGM to help gain insight into specific glucose profiles as they relate to glycaemic targets and pregnancy outcomes. Despite new studies comparing insulin pump therapy to multiple daily injections, its effectiveness in improving glucose and pregnancy outcomes remains unclear. Sensor-integrated insulin delivery (also called artificial pancreas or closed-loop insulin delivery) in pregnancy has been demonstrated to improve time in target and performs well despite the changing insulin demands of pregnancy. Summary Emerging technologies show promise in the management of type 1 diabetes in pregnancy; however, research must continue to keep up as technology advances. Further research is needed to clarify the role technology can play in optimising glucose control before and during pregnancy as well as to understand which women are candidates for sensorintegrated insulin delivery

Conclusions

Emerging technologies in the treatment of type 1 diabetes in pregnancy including CGM, insulin pumps and most recently sensor-integrated insulin delivery show promise in the management of this challenging condition. However, barriers such as cost and the education necessary for each technology must also be considered. The speed of the progress of these technologies offers improvements in accuracy, performance and device burdens associated with their use but also makes it challenging for clinicians to keep up with this ever-changing landscape. An understanding of the current literature is essential, as previously done studies with older devices may not be generalisable to the latest technologies. It also challenges clinicians and women with diabetes to understand and expertly use the various new systems.

Many women with type 1 diabetes put in a tremendous effort in managing their diabetes and may face feelings of concern when their glucose is out of target, pressure to achieve optimal glycaemic control, concern regarding previous pregnancy complications and a desire for a “normal” pregnancy [40, 41]. Despite this, many are unable to achieve guidelinerecommended glycaemic targets [6••]. We must find treatments for diabetes that are effective but not all consuming. Technology in the treatment of diabetes may allow us to do so, but there is still much work to be done. It is essential that research continues to keep a fast pace as technology advances and that the perspective of women with type 1 diabetes be taken into consideration as we move forward. The latest evidence suggests that CGM should be offered to all women on intensive insulin therapy. Future research is needed to optimise glucose control before pregnancy and to understand which women are candidates for sensor-integrated insulin delivery.