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• W2040561314 abstract "Diabetes mellitus complicates 5% of pregnancies and attempts to normalize blood sugar concentration have been proven to be the cornerstone of treatment. The variety of insulins available and patient commitment in self-monitoring of blood sugar have revolutionized the care of these women with diabetes in pregnancy. The use of short-acting insulin (SAI) to control postprandial glucose level together with intermediate-acting insulin (IAI) to control basal glucose level is well recognized. However this requires cooperation from patients and understanding of the disease process and would affect the pregnancy if control is inadequate. By using single type insulin it is hoped that patients’ compliance will be improved. This trial was designed to compare the outcomes of pregnancy in using SAI versus IAI alone in pregnant diabetic patients. A prospective controlled trial involved 68 patients with singleton pregnancy diagnosed with pregestational diabetes or gestational diabetes before 34 weeks’ gestation requiring insulin. They were randomized to either the SAI (receiving three doses of Actrapid (Novo Nordisk, Denmark)) or the IAI (receiving pre-bed Insulatard (Novo Nordisk, Denmark)) group. For SAI regime, the insulin was titrated at each clinic visit according to individual control, by 2–4 units increment to achieve fasting blood glucose of less than 5.5 mmol/l premeals, and prebed of 6 mmol/l. For the IAI group, a bedtime IAI was started to achieve values as described above. If these were still not controlled, despite dose increment, a morning dose was added. Diet control was given for two weeks and patients with inadequate dietary control were started on insulin regimes according to randomization. The exclusion criteria were pre-existing hypertension, renal disease, liver disease or autoimmune disorders, insulin treatment commencing after 34 weeks of gestation, and known poorly controlled blood sugar. Investigations such as blood sugar profiles, serum HbA1c, serum fructosamine, renal profile, and pregnancy ultrasound scan were done and home monitoring of blood glucose was recorded. The patients were seen in the Combined Clinic (obstetrician, endocrinologist, and dietician) and infants were delivered at 38 weeks according to hospital diabetic pregnancy protocol. The attending doctors were blinded to treatment regimes. The Research and Ethics Committee of our institution approved this study. The collected data were analyzed with SPSS version 12.0 using t-test, ξ2-test, Fisher's exact test, and nonparametric test as applicable. Maternal parameters and glycemic control were comparable in both groups (see Table I). The mean capillary blood sugar was 5.32±0.43 versus 5.42±0.39 mmol/l (p = 0.33) in SAI and IAI groups. There was no difference in achieving adequate control of blood sugar (76.7% SAI versus 80.6% IAI; p = 0.70). Although all other pre-meal blood sugar values were comparable in both groups, the pre-bed values were significantly higher in the IAI group (median 5.60 (0.60) versus 5.50 (5.50) mmol/l; p = 0.03). Maternal complications were not statistically significant in both groups. The mean birth weight of babies in the IAI group was heavier (3.16±0.63 versus 3.08±0.33 kg; p = 0.20) with more macrosomic infants (16.1% versus 0%; p = 0.05). Neonatal complications were similar in both groups’ babies. Earlier studies of four daily dosings of SAI did not show a further reduction of macrosomic infants 1. However, the presence of postprandial hyperglycemia (which could be controlled by SAI) has resulted in macrosomic babies 2, 3, as was also seen in this study. The SAI group required a higher level of total insulin, which was also noted in other studies 2, 3, as compared to the IAI group. Although the mean capillary blood sugar was found to be higher in the IAI group, the overall glycemic control is better. This finding was in contrast to another study 1. This reflected better patient compliance to treatment with longer interval of IAI injections. There were two cases of hypoglycemia in the SAI group compared to none in the IAI group, which lowered patient compliance towards injecting SAI after the incident. There were no major morbidity or mortality issues either for mothers and fetuses. This study has shown that IAI alone is comparable in achieving adequate control of blood glucose in diabetic pregnancy, with better patient compliance, although fetal macrosomia is a possible risk." @default.
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• W2040561314 date "2007-04-01" @default.
• W2040561314 modified "2023-10-14" @default.
• W2040561314 title "Comparative study of two insulin regimes in pregnancy complicated by diabetes mellitus" @default.
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• W2040561314 doi "https://doi.org/10.1080/00016340601147541" @default.
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