Kidneys cytomembranes stability in pregnant women with type 1 diabetes and pregnancy outcomes depending on the method of insulin delivery

Objective.
To evaluate of kidney cytomembranes stability during pregnancy and its outcomes in patients with diabetes mellitus type on type 1 with different stages of diabetic nephropathy (DN) according to the route of insulin administration.
Materials and Methods.
We study 100 pregnant women with type 1 diabetes with the introduction of insulin in the mode of multiple subcutaneous injections (MSII) and with portable dispenser with a continuous subcutaneous insulin infusion (CSII). DN stage determined by the level of albumin in the daily urine. Cytomembranes stability assessment conducted on daily excretion of ethanolamine and phospholipids with urine in each trimester. Pregnancy outcomes were analyzed in 52 patients with type 1 diabetes. In the group of pregnant women with delivery at term 38-40 weeks we also analyzed the status of newborns.
Results.
Indicators of cytomembranes stability of kidneys in pregnant women on CSII consistent with those in healthy pregnant women (p>0.05) the whole pregnancy, regardless of the level of daily urinary albumin excretion. There were no differences in cytomembrana stability of kidneys between the group of patients on MSII with normal albumin excretion (NAU) and the control group regardless to the gestational age (p>0.05). With the introduction of insulin in the mode of MSII on the stage of microalbuminuria (MAU) in the 3rd trimester we found the increase of ethanolamine excretion as compared to control groupy (U=8,00, p=0.012) and the group on CSII with a similar stage of nephropathy (U=2.00, p=0.033). In patients with proteinuria (PU) in the group on the MSII in the third trimester phospholipids excretion is increased with a daily urine (U=27,5, p=0.03 and U=22,00, p=0.07 for patients MSII and CSII, respectively). The use of an insulin pump allowed to prolong gestational period, even in severe proteinuric stage of nephropathy. Manifestations of diabetic fetopathy as macrosomia, hypoglycemia in the fetus at birth time mothers using CSII mode were less common than with MSII (p=0.01 and p=0.04, respectively). In the CSII group no resuscitation was needed, as opposed to 20% of children whose mothers used the MSII.
Conclusion.
The administration of insulin using portable dispenser the of mode CSII during pregnancy in patients with type 1 diabetes, even at the initial stage of the DN the cytomembranes stability is saved, pregnancy outcomes are improved.

diabetes mellitus, pregnancy, renal cytomembranes stability, pregnancy outcomes, pump, portable dispenser

1. Cornelis T, Odutayo А, Keunen J, Hladunewich M. The kidney in normal pregnancy and preeclampsia. Semin Nephrol. 2011 Jan; 31(1):4-14. DOI: 10.1016/j.semnephrol. 2010.10.002.

2. Reece EA, Coustan DR, Hayslett JP, Holford T, Coulehan J, O'Connor TZ, Hobbins JC. Diabetic nephropathy. Pregnancy performance and fetomaternal Outcome. Am J Obstet Gynecol. 1988 Jul;159 (1):56-66.

3. Maksimova OV. Osobennosti lipidnogo sostava eritrotsitarnykh membran u bol'nykh sakharnym diabetom. Probl endokrinol. 1989; (2):14-18.

4. Nelaeva AA. Klinikometabolicheskie osobennosti membrannykh narusheniy elementov krovi u bol'nykh insulinzavisimym sakharnym diabetom [Dissertation]. - Tyumen', 1997. 40 p.

5. Aleksandrova EA. Sostoyanie membran trombotsitov u bol'nykh sakharnym diabetom 1 tipa v zavisimosti ot stadii diabeticheskoy nefropatii. [Disertaton]. Tyumen', 2002. 18 p.

6. Berdichevskiy BA, Ivanov VV, Ovchinnikov AA. Sostoyanie membranodestabiliziruyushchikh protsessov u patsientov c khronicheskim obstruktivnym pielonefritom. Nauchnyy vestnik TGMA «Aktual'nye voprosy urologii». 2001; (2).

7. Ignatova MS. Problemy i sostoyanie pochechnykh membran pri nefropatiyakh u detey. In: Problemy membrannoy patologii v pediatrii. 1984; 80-89.

8. Vel'tishchev YuE. Kletochnye membrany i patologiya detskogo vozrasta. In: Problemy membrannoy patologii v pediatrii. 1984;5-9.

9. Vel'tishchev YuE, Yur'eva EA, Musaev MA, Shemanova GF. Fosfolipazy cheloveka v norme i pri patologii. Voprosy med. khimii. 1981; (4):441-449.

10. Gribanov GA. Osobennosti struktury i biologicheskaya rol' lizofosfolipidov. Voprosy med. khimii. 1991; 37 (4):2-10.

11. Maksina AG, Daynyak BA, Troitskaya SYu, Fedotova EA Biofizicheskie kharakteristiki lipidnogo bisloya membran eritrotsitov pri sakharnom diabete [Conference materials]. Materialy IV Vserossiyskogo kongressa endokrinologov. Aktual'nye problemy sovremennoy endokrinologii. SanktPeterburg. 2001; 118.

12. Tsvettsikh VE. Klinikopatogeneticheskaya rol' narusheniy strukturnofunktsional'noy organizatsii kletochnykh membran u bol'nykh khronicheskim pielonefritom [Dissertation]. Perm', 1989. 18 p.

13. Demidova IYu, Arbatskaya NYu, Mel'nikova EP. Selection of insulin therapy method in pregnant women with type 1 diabetes mellitus. Farmateka. 2008; 17 (171):76-82.

14. Guilhem I, Balkau B, Lecordier F, Malecot JM, Elbadii S, Leguerrier AM, Poirier JY, Derrien C, Bonnet F. Insulin pump failures are still frequent: a prospective study over 6 years from 2001 to 2007. Diabetologia. 2009; (53):2662- 2664.

15. Arbatskaya N, Ignatova N, Melnikova E. Effectiveness and safety of CSII during pregnancy. 5'1' International symposium on Diabetes and Pregnancy. 2008 March 26-28. Italy, Sorrento. Abstract book:255.

16. Tiselko A, Potin V, Borovik N. Continuous subcutaneous insulin infusion (CSII),continuous glucose monitoring (CGM) in type 1 diabetes mellitus (DM1) patients during pregnancy and delivery. The 6th International Symposium on Diabetes and Pregnancy (DIP 2011). Salzburg, Austria, March 2011; Abstr. 332.

17. Esayan R, Degtyareva E, Shestakova M. Insulin pump therapy in patients with type 1 diabetes mellitus during pregnancy and labor. The 6th International Symposium on Diabetes and Pregnancy (DIP 2011). Salzburg, Austria, March 2011; Abstr. 514.

18. Ansaldi E, Balbo M, Carratta L, Trifoglio O. Insulin pump during labour and delivery: a preliminary experience. The 6th International Symposium on Diabetes and Pregnancy (DIP 2011). Salzburg, Austria, March 2011; Abstr. 369.

19. Webster D, Ulahannan T. Review of pregnancy outcomes in diabetic women on continuous subcutaneous. The 6th International Symposium on Diabetes and Pregnancy (DIP 2011). Salzburg, Austria, March 2011; Abstr. 351.

20. Antsiferov MB, Koteshkova OM, Kleymenova SA. Continuous subcutaneous insulin infusion: effective method for control of type 1 diabetes mellitus. Farmateka. 2010; (16):38-45.