Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
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Insulin Glargine versus NPH Insulin for the Management of
Pre-existing Diabetes in Pregnancy
Loretta Hothersall Ph.D., FNPC. Maine Centers for Endocrinology
and Diabetes 175 Route One, Scarborough, Maine, 04074 USA. (1-
207) 885-7710. hothel@mmc.org
Elaine Caron MS, RN,CDE. Maine Centers for Endocrinology and
Diabetes 175 Route One, Scarborough, Maine 04074,USA
Insulin therapy becomes an integral part of management for women
with pre-existing diabetes and pregnancy. Tight glycemic control
can be attained with multiple daily injections of human insulin.
Conventional therapy (NPH) may result in frequent hypoglycemic
events with rebounding hyperglycemia. Serum ketosis may develop
having a deleterious impact upon both mother and fetus. This study
addressed the use of Glargine insulin (a recombinant human insulin
analog) in pregnancy.
To date there is limited research and no well controlled clinical
studies in the use of Glargine insulin in pregnancy as well as the
lack of FDA approval. Therefore many practices are hesitant to have
patients continue on the analog. Usually women are converted back
to conventional therapy (NPH) which leads to a period of suboptimal
control. During this period of hyperglycemia there is increased risk
for perinatal complications. The lack of safety data (in the continued
use of Glargine) usually becomes a clinical decision by the provider.
This study assessed a matched cohort of pregnant women with
either type 1 diabetes or type 2 diabetes who chose to remain on
Glargine insulin versus those women with either type 1 diabetes or
type 2 diabetes who chose to remain or opted to switch to NPH
insulin during their pregnancies. The purpose of the study was to
evaluate the frequency of hypoglycemic events, the over all
glycemic control of women in both groups, the incidence of perinatal
complications as well as the incidence of neonatal complications.
It was proposed that glycemic control would be as good in those
women who chose to remain on Glargine insulin versus the glycemic
control of those women who chose conventional therapy (NPH). The
rate of fetal /neonatal complications such as neural tube defects,
cardiac anomalies, macrosomia, respiratory distress syndrome,
neonatal hypoglycemia, and hyperbilirubinemia would be no greater
in the offspring of those women who chose to remain on Glargine
insulin
Versus the offspring of those women on conventional therapy
(NPH).
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