Question

A 30-year-old woman with type 1 diabetes is planning pregnancy. Her current HbA1c is 7.8%, creatinine 70 µmol/L, and she takes basal-bolus insulin and an ACE inhibitor for microalbuminuria. According to Diabetes Canada and SOGC guidance, which pre-conception intervention is most appropriate?

Accepted Answer

Aim to improve glycaemic control to HbA1c ≤7.0% (ideally ≤6.5%) and stop ACE inhibitor before conception

Answer

Advise that current HbA1c is acceptable and no change is needed before conception

Answer

Increase ACE inhibitor dose to further reduce albuminuria

Answer

Switch from insulin to an SGLT2 inhibitor

Answer

Start high-dose statin therapy before conception

Practice question

A 30-year-old woman with type 1 diabetes is planning pregnancy. Her current HbA1c is 7.8%, creatinine 70 µmol/L, and she takes basal-bolus insulin and an ACE inhibitor for microalbuminuria. According to Diabetes Canada and SOGC guidance, which pre-conception intervention is most appropriate?