Abstract
The objective of this study is to assess the insulin requirement, its determinants, and its association with maternal complications and neonatal outcome in women with pregestational type 2 diabetes mellitus. One hundred two insulin treated pregnant women with pre-existing type 2 diabetes and those clinically diagnosed with type2 DM during pregnancy were selected. Insulin dose, distribution, relation with meal was assessed. Statistical analysis was done and insulin requirement was correlated with maternal factors and fetal outcome. Insulin dose at the 1st trimester was 32.65 ± 23.11 units/day, i.e., 0.52 U/kg/day of pre-pregnancy weight, which significantly increased to 47.62 ± 29.54 U/day at delivery i.e., 0.76 U/kg/day (p < 0.0001). Insulin dose was positively correlated to fasting and 2 h postprandial plasma glucose at diagnosis. Pre-dinner insulin requirement was significantly higher than pre-breakfast in the 3rd trimester (P value: 0.018). 19.6% neonates had a low birth weight, 5.8% had macrosomia, and 18.63% had neonatal hypoglycemia. Subjects on insulin analog showed a lower risk of low birth weight (17.4%) and macrosomia (Nil) versus those on conventional insulin with 21.6 and 8.1%, respectively. Insulin requirement in type 2 diabetes pregnancies progressively increases from the 1st trimester till delivery. Meal-related assessment needs attention in Indian population due to their varied dietary culture. Low birth weight is more frequent than macrosomia in our population. More studies are needed to ascertain the concept of a better neonatal outcome with insulin analog.
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References
IDF Diabetes Atlas, 7th Edition, 2015.
Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet. 2015;131(Suppl 3):S173–211.
Jovanovic L, Druzin M, Peterson CM. Effect of euglycemia on the outcome of pregnancy in insulin-dependent diabetic women as compared with normal control subjects. Am J Med. 1981;71(921)
Jovanovic-Peterson L, Peterson CM, Reed GF, Metzger BE, Mills JL, Knopp RH, Aarons JH. Maternal postprandial glucose levels and infant birth weight: the diabetes in early pregnancy study. The National Institute of Child Health and Human Development--Diabetes in Early Pregnancy Study. Am J Obstet Gynecol. 1991;164(1 Pt 1):103–11.
Jovanovic L, Pettitt DJ. Treatment with insulin and its analogs in pregnancies complicated by diabetes. Diabetes Care. 2007;30(Supplement 2):S220–4. doi:10.2337/dc07-s220.
Kitzmiller JL, Block JM, Brown FM, Catalano PM, Conway DL, Coustan DR, et al. Managing Preexisting Diabetes for Pregnancy. Diabetes Care. 2008;31(5):1060–79. doi:10.2337/dc08-9020.
Jovanovic L, Kitzmiller JL. Insulin therapy in pregnancy. In: Text- book of diabetes and pregnancy. 2.ed. Hod H, Jovanovic L, Di Renzo GC, de Leiva A, Langer O, eds. London: Informa Health- care; 2008. p. 205–216.)
Carlos Antonio Negrato, Renan Magalhães Montenegro Junior, Lilia Maria Von Kostrisch, Maria Fatima Guedes, Rosiane Mattar, Marilia B. Gomes; Insulin analogues in the treatment of diabetes in pregnancy, Arq Bras Endocrinol Metab. 2012;56/7.
Durnwald CP, Landon MB. A comparison of lispro and regular insulin for the management of type 1 and type 2 diabetes in pregnancy. J Matern Fetal Neonatal Med. 2008;21(5):309–13.
R Chaudry, P Gilby, P V Carroll, Pre-Existing (Type 1 And Type 2) Diabetes In Pregnancy Obstetrics, Gynaecology and Reproductive Medicine 17:12; 2007 Elsevier Ltd.
Sapienza AD, Francisco RPV, Trindade TC, Zugaib M. Factors predicting the need for insulin therapy in patients with gestational diabetes mellitus. Diabetes Res Clin Pract. 2010;88:81–6.
Pettitt DJ, Ospina P, Kolaczynski J, Jovanovic L. Comparison of an insulin analog, insulin aspart, and regular human insulin with no insulin in gestational diabetes mellitus. Diabetes Care. 2003;26:183–6.
Seshiah V, Balaji V. Insulin analogue therapy in pregnancy with diabetes. J Assoc Physicians India. 2009;57(Suppl):S34–7.
Jovanovic L, Ilic S, Pettitt DJ, Hugo K, Gutierrez M, Bowsher RR, et al. Metabolic and immunologic effects of insulin lispro in gestational diabetes. Diabetes Care. 1999;22:1422–7.
Mecacci F, Carignani L, Cioni R, Bartoli E, Parretti E, La Torre P, et al. Maternal metabolic control and perinatal outcome in women with gestational diabetes treated with regular or lispro insulin: comparison with nondiabetic pregnant women. Eur J Obstet Gynecol Reprod Biol. 2003;111:19–24.
M.C. Deepaklal, Kurian Joseph, Rekha Kurian, Nandita a. Thakkar, Efficacy of insulin lispro in improving glycemic control in gestational diabetes. Indian J Endocrinol Metab 2014; 18(4): 491–495. doi: 10.4103/22308210.137492.
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Dr. Dhananjay Raje for the statistical assistance.
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This study is approved by the Institutional Ethics Committee, though it is retrospective noncontrolled observational study. There is no intervention as insulin was given to the women participants as part of the standard of care and not as part of any study; the authors only documented the dose, type, and duration of insulin that were administered to the participants.
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Informed consent from all the subjects was taken for using their personal data for research purposes.
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Gupta, S., Gupta, K., Gathe, S. et al. Insulin therapy in women with pregestational type 2 diabetes and its relevance to maternal and neonatal complications. Int J Diabetes Dev Ctries 38, 47–54 (2018). https://doi.org/10.1007/s13410-016-0541-2
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DOI: https://doi.org/10.1007/s13410-016-0541-2