Abstract：
OBJECTIVE: This study aimed to describe the relationship between breastfeeding episodes and maternal glucose levels, and to assess whether this differs with closed-loop vs open-loop (sensor-augmented pump) insulin therapy.
METHODS: Infant-feeding diaries were collected at 6 weeks, 12 weeks and 24 weeks postpartum in a trial of postpartum closed-loop use in 18 women with type 1 diabetes. Continuous glucose monitoring (CGM) data were used to identify maternal glucose patterns within the 3 h of breastfeeding episodes. Generalised mixed models adjusted for breastfeeding episodes in the same woman, repeat breastfeeding episodes, carbohydrate intake, infant age at time of feeding and early pregnancy HbA1c. This was a secondary analysis of data collected during a randomised trial (ClinicalTrials.gov registration no. NCT04420728).
RESULTS: CGM glucose remained above 3.9 mmol/l in the 3 h post-breastfeeding for 93% (397/427) of breastfeeding episodes. There was an overall decrease in glucose at nighttime within 3 h of breastfeeding (1.1 mmol l-1 h-1 decrease on average; p=0.009). A decrease in nighttime glucose was observed with open-loop therapy (1.2 ± 0.5 mmol/l) but was blunted with closed-loop therapy (0.4 ± 0.3 mmol/l; p<0.01, open-loop vs closed-loop).
CONCLUSIONS: There is a small decrease in glucose after nighttime breastfeeding that usually does not result in maternal hypoglycaemia; this appears to be blunted with the use of closed-loop therapy.
METHODS: Infant-feeding diaries were collected at 6 weeks, 12 weeks and 24 weeks postpartum in a trial of postpartum closed-loop use in 18 women with type 1 diabetes. Continuous glucose monitoring (CGM) data were used to identify maternal glucose patterns within the 3 h of breastfeeding episodes. Generalised mixed models adjusted for breastfeeding episodes in the same woman, repeat breastfeeding episodes, carbohydrate intake, infant age at time of feeding and early pregnancy HbA1c. This was a secondary analysis of data collected during a randomised trial (ClinicalTrials.gov registration no. NCT04420728).
RESULTS: CGM glucose remained above 3.9 mmol/l in the 3 h post-breastfeeding for 93% (397/427) of breastfeeding episodes. There was an overall decrease in glucose at nighttime within 3 h of breastfeeding (1.1 mmol l-1 h-1 decrease on average; p=0.009). A decrease in nighttime glucose was observed with open-loop therapy (1.2 ± 0.5 mmol/l) but was blunted with closed-loop therapy (0.4 ± 0.3 mmol/l; p<0.01, open-loop vs closed-loop).
CONCLUSIONS: There is a small decrease in glucose after nighttime breastfeeding that usually does not result in maternal hypoglycaemia; this appears to be blunted with the use of closed-loop therapy.
摘要：
目的：本研究旨在描述母乳喂养事件与产妇血糖水平之间的关系，并评估闭环与开环（传感器增强泵）胰岛素治疗是否不同。
方法：在第6周收集婴儿喂养日记，在18名1型糖尿病妇女中进行产后闭环使用的试验中，产后12周和24周。连续血糖监测（CGM）数据用于确定母乳喂养3小时内的母体血糖模式。针对同一女性的母乳喂养事件调整后的广义混合模型，重复母乳喂养，碳水化合物的摄入量，喂养时的婴儿年龄和早期妊娠HbA1c。这是对随机试验期间收集的数据的二次分析(ClinicalTrials.gov注册号。NCT04420728)。
结果：在93％（397/427）母乳喂养后3小时，CGM葡萄糖保持在3.9mmol/l以上。母乳喂养后3小时内夜间血糖总体下降（平均下降1.1mmoll-1h-1；p=0.009）。开环治疗观察到夜间血糖下降（1.2±0.5mmol/l），但闭环治疗减弱（0.4±0.3mmol/l；p<0.01，开环与闭环）。
结论：夜间母乳喂养后血糖有少量下降，通常不会导致产妇低血糖；使用闭环疗法似乎会减弱这种下降。
方法：在第6周收集婴儿喂养日记，在18名1型糖尿病妇女中进行产后闭环使用的试验中，产后12周和24周。连续血糖监测（CGM）数据用于确定母乳喂养3小时内的母体血糖模式。针对同一女性的母乳喂养事件调整后的广义混合模型，重复母乳喂养，碳水化合物的摄入量，喂养时的婴儿年龄和早期妊娠HbA1c。这是对随机试验期间收集的数据的二次分析(ClinicalTrials.gov注册号。NCT04420728)。
结果：在93％（397/427）母乳喂养后3小时，CGM葡萄糖保持在3.9mmol/l以上。母乳喂养后3小时内夜间血糖总体下降（平均下降1.1mmoll-1h-1；p=0.009）。开环治疗观察到夜间血糖下降（1.2±0.5mmol/l），但闭环治疗减弱（0.4±0.3mmol/l；p<0.01，开环与闭环）。
结论：夜间母乳喂养后血糖有少量下降，通常不会导致产妇低血糖；使用闭环疗法似乎会减弱这种下降。
