Comparative study between use of long acting insulin versus multiple dose regimen in control of Gestational Diabetes Mellitus: a randomized controlled trial

Abstract

Objective: The aim of our work is comparison between long acting insulin and multiple dose regimens in control of gestational diabetes Patients and Methods: This is a prospective randomized controlled trialincluded Pregnant women with gestational age between (24 and 28 weeks) fail to achieve adequate glycaemic levels after a 75 g oral glucose tolerance test (OGTT). 74 After taking patients' consent the patients had been informed about the study and procedures then randomized into two groups: • Group A: received long acting insulin analogs as a single dose (insulin glargine) one daily injection of long-acting insulin at an initial dose of (0.44 IU/kg) once daily at bedtime (Rosenstock et al., 2008; Poyhonen-Alho et al., 2002). • Group B: received intermediate acting insulin (NPH) besides short acting insulin (lispro) in divided doses. Results: Means of Pre-treatment FBS, 2h-PPBS and HbA1c are near each other at both groups with no statistically significant difference between groups while group B shows lower statistically significant time to control blood sugar than group A (10+1 vs 14+2, respectively). ■ There is no statistically significant difference between groups regarding Maternal hypoglycemia. ■ Group A has higher nonsignificant bad obstetric complication as PIH, Preterm delivery, Shoulder dystocia and CS delivery rate and lower Polyhydramnios rate than group B. Group (A) has higher nonsignificantFetal/Neonatal outcomes as Fetal macrosomia, Congenital anomalie, IUFD, NICU admission and Neonatal death than group (B) by Per protocol (PP) analysis Conclusion: We can conclude that, there is no clinical difference between using multiple dose regimen and use of long acting insulin analogues in control of gestational diabetes regarding maternal and fetal outcomes. However multiple dose regimen needs shorter time for blood glucose control than long acting insulin .It is to be noted that long acting insulin is more expensive.