Comparison of insulin glargine or insulin detemir versus insulin NPH in pregestational and gestational diabetes Allyson Sleeman, Jessica Odom, Megan Schellinger, Jun Wu Greenville Hospital System PGY1 - Greenville, SC
Background/Purpose: Current guideline recommendations are inconclusive regarding which type(s) of insulin are preferred for achieving tight glycemic control during pregnancy. Several clinicians at the Greenville Health System OB/GYN Center have transitioned to using insulin glargine or insulin detemir as a preferred regimen given their favorable pharmacokinetic parameters. The objective of this study is to evaluate if an insulin glargine or insulin detemir-based regimen results in less hypoglycemic events, hospital admissions, or delivery complications compared to an NPH-based regimen in pregestational and gestational patients.
Methodology: This retrospective, observational cohort study compares the use of insulin glargine or insulin detemir to insulin NPH in women who are 18 years or older, diagnosed with pregestational or gestational diabetes, currently receiving insulin therapy during pregnancy, and seen at Greenville Health System OB/GYN Center. Women who have not yet delivered, use insulin pumps, or use insulin degludec or concentrated insulins were excluded. The primary outcome is the frequency of hypoglycemic episodes, defined as blood glucose of less than 60 mg/dL. Secondary outcomes include emergency room visits and hospitalizations secondary to diabetes prior to delivery, duration of time with glycemic control during pregnancy, and maternal and neonatal complications. Results of this study will be used to promote consistent prescribing practices that will minimize maternal and neonatal complications as well as maintain tight glycemic control without an increase in hypoglycemia.
Presentation Objective: To evaluate if insulin glargine or insulin detemir is a preferred alternative to insulin NPH in pregestational and gestational patients.
Self-Assessment: What are the risks associated with uncontrolled glucose in pregestational and gestational diabetes?
