Comparative study of two insulin regimes in pregnancy complicated by diabetes mellitus (original) (raw)
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Gestational Diabetes Mellitus: Insulinic Management
The Journal of Obstetrics and Gynecology of India, 2014
Diabetic pregnancies have attendant risks. Adverse fetal, neonatal, and maternal outcomes in a diabetic pregnancy can be avoided by optimum glycemic control. Most pregnancies with GDM can be managed with noninsulinic management, which includes medical nutrition therapy. However, many necessitate concomitant insulinic management. The new insulin analogs present undoubted advantages in reducing the risk of hypoglycemia, mainly during the night, and in promoting a more physiologic glycemic profile in pregnant women with diabetes. Rapidacting insulin analogs seem to be safe and efficient in reducing postprandial glucose levels more proficiently than regular human insulin, with less hypoglycemia. The longacting insulin analogs do not have a pronounced peak effect as NPH insulin, and cause less hypoglycemia, mainly during the night. The review focuses on glycemic goals in pregnancy, insulinic management of GDM, and posology of insulin and its analogs. Clear understanding of the insulinic management of GDM is essential for women's health care providers to provide comprehensive care to women whose pregnancies are complicated with diabetes and rechristen the ''diabetic capital of the world'' to the ''diabetic care capital of the world.''
Objective To compare perinatal outcome and glycaemic control in two groups of pregnant diabetic patients receiving two insulin regimens. Design Randomised controlled open label study. Setting University affiliated hospital, Israel. Participants 138 patients with gestational diabetes mellitus and 58 patients with pregestational diabetes mellitus received insulin four times daily, and 136 patients with gestational diabetes and 60 patients with pregestational diabetes received insulin twice daily. Intervention Three doses of regular insulin before meals and an intermediate insulin dose before bedtime (four times daily regimen), and a combination of regular and intermediate insulin in the morning and evening (twice daily regimen). Main outcome measures Maternal glycaemic control and perinatal outcome. Results Mean daily insulin concentration before birth was higher in the women receiving insulin four times daily compared with twice daily: by 22 units (95% confidence interval 12 to 32) in patients with gestational diabetes and by 28 units (15 to 41) in patients with pregestational diabetes. Glycaemic control was better with the four times daily regimen than with the twice daily regimen: in patients with gestational diabetes mean blood glucose concentrations decreased by 0.19 mmol/l (0.13 to 0.25), HbA 1c by 0.3% (0.2% to 0.4%), and fructosamine by 41 mol/l (37 to 45), and adequate glycaemic control (mean blood glucose concentration < 5.8 mmol/l) was achieved in 17% (8% to 26%) more women; in patients with pregestational diabetes mean blood glucose concentration decreased by 0.44 mmol/l (0.28 to 0.60), HbA 1c by 0.5% (0.2% to 0.8%), and fructosamine by 51 mol/l (45 to 57), and adequate glycaemic control was achieved in 31% (15% to 47%) more women. Maternal severe hypoglycaemic events, caesarean section, preterm birth, macrosomia, and low Apgar scores were similar in both dose groups. In women with gestational diabetes the four times daily regimen resulted in a lower rate of overall neonatal morbidity than the twice daily regimen (relative risk 0.59, 0.38 to 0.92), and the relative risk for hyperbilirubinaemia and hypoglycaemia was lower (0.51, 0.29 to 0.91 and 0.12, 0.02 to 0.97 respectively). The relative risk of hypoglycaemia in newborn infants to mothers with pregestational diabetes was 0.17 (0.04 to 0.74). Conclusions Giving insulin four times rather than twice daily in pregnancy improved glycaemic control and perinatal outcome without further risking the mother.
Glycemic Control in Pregnant Diabetic Woman: Comparison between Conventional Insulin and Analogs
Journal of Diabetes & Metabolism, 2017
Background: Pregnancy in diabetic women is at high-risk of maternal and fetal complications. Insulin which remains the main treatment during pregnancy is not devoid of adverse effects mainly hypoglycemia and weight gain. The objective of our study was to evaluate the efficiency and safety of insulin analogs compared to conventional insulin in a group of pregnant women with diabetes. Methods: A prospective longitudinal study comparing two groups of diabetic pregnant women (including type 1(T1DM) and type 2 diabetes mellitus (T2DM)): group 1 (G1) made of 43 patients on conventional insulin and group 2 (G2) made of 30 patients on analogues. Patients were enrolled at a gestational age before 12 weeks and were followed until childbirth. Results: At baseline, age, types of diabetes, duration of diabetes and average HbA1c at the first trimester were similar between treatment groups. Upon study of glycemic profiles, in the third trimester, the mean group 2 fasting plasma glucose (FPG) was lower compared to group 1(G1: 1.19 ± 0.32 g/l vs. G2: 1.05 ± 0.26 g/l; p=0.06). Mean evening pre-prandial glucose was although significantly higher in group 2 in the 1 st and 2 nd trimesters became comparable to that in group 1 in the 3rd quarter, indeed a significant improvement with insulin analogues was shown (p=0.042). The rest of the glycemic profile was comparable in both groups as well as HbA1c levels throughout pregnancy (HbA1c T3: G1: 6.7 ± 1.2 % vs. G2: 7.18 ± 1.1%; p=0.16). The episodes of nocturnal and severe hypoglycemia were similar in both groups. Weight gain was lower in G2 than in G1 but the difference was not significant (G1: 10.27 ± 5.46 kg versus G2: 7.69 ± 5.34 kg; p=0.082). Conclusion: Our study showed that insulin analogs were not inferior to conventional insulin to achieve glycemic control during pregnancy.
Gestational diabetes: Insulin requirements in pregnancy
American Journal of Obstetrics and Gynecology, 1987
A prospective study of 57 women with gestational diabetes mellitus was undertaken to determine actual insulin requirements throughout pregnancy. Women were placed on a multiple injection, mixed insulin regimen and monitored their blood glucose level 6.5 ± 1 times per day using a memory-based reflectance meter to obtain verified data. A significant (p < 0.01) increase in total insulin dose was found during the initial treatment period (7 ± 2 days) until the target glucose range was achieved. Insulin requirements continued to significantly (p < 0.01) rise until 30 ± 1 gestational weeks, despite a stabilization of glucose level. Thereafter, there was no significant change (3%) in insulin requirement. A correlation of r = 0.58 (p < 0.001) for the relationship between insulin dose at the 24 and 32 weeks' gestation, and an r = 0.99 (p < 0.0001) for the relationship between insulin dose at 32 and 39 weeks' gestation was found. We concluded that an emphasis on ambulatory blood glucose control and insulin adjustments should occur in the early treatment phase of gestational diabetes.
Effect of Different Insulin Therapies on Obstetric-Fetal Outcomes
Scientific Reports
To evaluate the effectiveness of the different insulin therapies on obstetrics-fetal outcomes in women with pregestational diabetes mellitus. We enrolled 147 pregnant women with pre-existing type 1 or 2 diabetes mellitus. Clinical and biochemical parameters were analysed in relation to obstetric and fetal outcomes. 14.2% received treatment with Neutral Protamine Hagedorn insulin and short-acting insulin analogues; 19% with premixed human insulin; 40.1% with insulin glargine and lispro, 6.2% with detemir and aspart and 20% with continuous subcutaneous insulin infusion. All 5 types of treatment achieved a reduction of the mean HbA1c during pregnancy (p = 0.01). Pre-pregnancy care was carried out for 48% of patients. We found no statistically significant differences between the different insulin therapies and the obstetric-fetal outcomes. In conclusión, the different insulin therapies used in patients with pregestational diabetes mellitus does not seem to affect obstetric-fetal outcomes.
Objective To compare perinatal outcome and glycaemic control in two groups of pregnant diabetic patients receiving two insulin regimens.
Diabetologia, 2010
Aims/hypothesis The aim of the study was to analyse the insulin requirements of women with type 1 diabetes mellitus throughout pregnancy. Methods We have examined the weekly mean blood glucose (mmol/l), insulin requirements (U kg −1 day −1 ) and total insulin requirements (U/day) in 65 women with type 1 diabetes mellitus and tight metabolic control since before pregnancy (HbA 1c ≤6.0%). Results Both insulin requirement and total insulin requirement displayed a peak in week 9, a nadir in week 16 and a second peak in week 37. For the change in insulin requirement (4.08% per week) and in total insulin requirement (5.19% per week), the sharpest slope was observed from week 16 to week 37. However, two changes of direction took place in the first 11 weeks and eight out of nine episodes of severe hypoglycaemia requiring treatment with glucagon or i.v. glucose took place in the first 16 weeks. Conclusions/interpretation Pregnant women with type 1 diabetes mellitus and tight metabolic control since before pregnancy displayed changes in insulin requirement and total insulin requirement with successive changes of direction. The sharpest slope was observed between 16 and 37 weeks, but insulin requirements were more unstable in the first 16 weeks. This information could help patients and physicians to react to changes in glycaemic pattern in a prompt and adequate way.
A Prospective Study of Glucose Control with Diet in Women with Gestational Diabetes Mellitus
INTRODUCTION: It is important to identify modifiable factors that may lower gestational diabetes mellitus (GDM) risk. Dietary iron is of particular interest given that iron is a strong prooxidant, and high body iron levels can damage pancreatic β-cell function and impair glucose metabolism. The current study is to determine if prepregnancy dietary and supplemental iron intakes are associated with the risk of GDM. MATERIALS AND METHODS: Study was done in Obstetrics and Gynecology department, MGM Medical College, Jamshedpur. Study duration was 1 years. It was a prospective study comprising of patients who came with raised blood glucose levels on their 1st visit. RESULTS: Prevalence of GDM (2.87%) is observed to be comparable to various other centers. Highest number of GDM cases was observed in age group of 26-30 years (62.96%). Control of glycemia with diet could be achieved in majority of women (53.85%) at 3 months post-partum as reflected by FBS levels. Incidence of Macrosomia (29.63%) and LSCS (77.78%) could not be lessened by glycemic control with diet in women with GDM. CONCLUSION: Prevalence of GDM was comparable to that of other studies. Rate of caesarean section was very high and main indications being foetal distress and cephalopelvic disproportion. Maternal and perinatal morbidity increases as duration of GDM increases. Control of glycemia with dietary treatment can help reduce occurrence of complications in mother and baby. It requires proper compliance, absence of which calls for need of insulin in most of patients with uncontrolled glycemia since first.