Patient-led insulin titration tied to hypoglycemia and low birth weights in gestational diabetes

A recent study found that Patient-led daily insulin titration causes higher insulin dose use, lower fasting glucose, and lower birth weights in gestational diabetes. The study was published in the journal 'Diabetic Medicine.' 

High birthweight babies and adverse pregnancy outcomes are seen in patients with increased fasting blood glucose levels in Gestational diabetes mellites (GDM). To improve the fasting glycaemic control in GDM a simple, patient-led, insulin dose titration algorithm was made and tested. 

A daily four-unit dose increase after every fasting glucose value ≥5.0 mmol/mol (90 mg/dl) was recommended in patients with GDM while initiating basal insulin. Pre-existing intensive (weekly) specialist nursing input was augmented. Insulin doses, glucose values at 36 weeks gestation, and maternal and neonatal outcomes were examined. The before-and-after retrospective observational study design was used to check the outcomes in 105 women completing pregnancy before and 93 women after the intervention. 

Results

• The baseline characteristics of women in the before and after groups were the same.
• Women initiated on insulin after implementation (n = 30 before, n = 43 after) achieved substantially higher doses at 36 weeks.
• 36-week mean fasting glucose was lower in those on insulin after implementation.
• There was a significant reduction in birth weight.
• There was no significant difference in macrosomia or cesarean sections.
• No women experienced severe hypoglycemia.
• There were no outcome differences before versus after intervention in women not treated with insulin.

Thus, the researchers concluded that higher insulin dose use and lower fasting glucose were observed in patient-led daily insulin titration in gestational diabetes and it is also associated with lower birthweight without causing significant hypoglycemia. 

To read the full article, click here:  https://doi.org/10.1111/dme.14926 

McGovern AP, Hirwa KD, Wong AK, et al. Patient-led rapid titration of basal insulin in gestational diabetes is associated with improved glycaemic control and lower birthweight [published online ahead of print, 2022 Jul 28]. Diabet Med. 2022;e14926.