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More Frequent Insulin Helps Pregnant Diabetics

Because good glycemic control is assumed to be beneficial for pregnant diabetic women, Israeli investigators performed a comparison of 2 different insulin regimens during pregnancy. A total of 392 women (118 with diabetes before pregnancy and 274 with gestational diabetes) were randomized to receive either (1) twice-daily short-acting and intermediate insulin or (2) three doses a day of short-acting insulin followed by a nighttime dose of intermediate insulin. All patients were evaluated throughout pregnancy. Insulin treatment was started at the same time in all groups.

Glycemic control, assessed by 3 different measures, was significantly better among those receiving 4 doses a day. Among women with gestational diabetes, 91 percent of the 4-times-daily group achieved adequate glycemic control, compared with 74 percent of the twice-daily group; among women with pregestational diabetes, the corresponding figures were 86 percent and 55 percent. The groups had similar rates of severe maternal hypoglycemia, cesarean sections, preterm births, macrosomia, and low infant Apgar scores. In women with gestational diabetes, the 4-times-daily group had significantly lower rates of neonatal hypoglycemia, neonatal hyperbilirubinemia, and overall neonatal morbidity. In women with pregestational diabetes, the 4-times-daily regimen was associated with a significantly lower rate of neonatal hypoglycemia.

Comment: The more intensive insulin regimen did not result in more maternal hypoglycemia. It did result in better glycemic control and, more importantly, somewhat better neonatal outcomes. Whether these results can be reproduced by physicians whose practices are not committed to caring for pregnant diabetics remains to be determined.

— KI Marton and RW Rebar

Published in Journal Watch General Medicine December 21, 1999

Citation(s):

Nachum Z et al. Twice daily versus four times daily insulin dose regimens for diabetes in pregnancy: Randomised controlled trial. BMJ 1999 Nov 6 319 1223-1227.

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