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Amini FG, Nia AF, Sharbafi MH, Khandari A, Gargari SS. Comparison between the effect of regular human insulin and NPH with novo-rapid and levemir insulin in glycemic control in gestational diabetes. Hum Antibodies 2019; 27:285-289. [PMID: 31156155 DOI: 10.3233/hab-190385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is one of the prevalent adverse conditions among pregnant women which needs delicate monitoring and control. GDM is a state in which the pregnant women's blood glucose level exceeds the normal range. Our goal was to determine the best therapeutic method to control the blood glucose level among GDM patients by comparing of the efficacy between two Insulin consisting, Novo-rapid + Levemir Insulin and Regular + NPH Insulin. METHOD In this double-blind, randomized clinical trial study, we enrolled 100 women with GDM as an inpatient. In group A, patients underwent treating with Regular + NPH Insulin, and in group B, patients underwent treating with Novo-rapid + Levemir Insulin. Patient's demographic and clinical information gathered by specified several times during the study and analysis performed by SPSS21. RESULTS Despite significant changes in the two groups patient's blood glucose levels; we could not find any remarkable differences between the two groups. In the case of patient and health care system satisfaction and the length of the hospitalization group, B was better than group A. CONCLUSION Altogether, The Novo-rapid and Levemir Insulin in comparing with the Regular and NPH Insulin were practically advantageous due to the simple using method and short hospitalization period of the patient. Thus, we prefer and suggest this beneficial method (using Novo-rapid and Levemir Insulin) to reach therapeutic goals.
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Affiliation(s)
- Fatemeh Ghaed Amini
- Department of Gynecology and Obstetrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Fesharki Nia
- Department of Gynecology and Obstetrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ayda Khandari
- Department of Gynecology and Obstetrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soraya Saleh Gargari
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Negrato CA, Rafacho A, Negrato G, Teixeira MF, Araújo CAR, Vieira L, Silva CA, Date SK, Demarchi AC, Gomes MB. Glargine vs. NPH insulin therapy in pregnancies complicated by diabetes: an observational cohort study. Diabetes Res Clin Pract 2010; 89:46-51. [PMID: 20378197 DOI: 10.1016/j.diabres.2010.03.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 03/07/2010] [Accepted: 03/14/2010] [Indexed: 12/28/2022]
Abstract
AIMS The effects of glargine insulin therapy in pregnancies are not well established. We compared maternal and neonatal outcomes of women with pregestational and gestational diabetes treated with glargine or NPH insulin. METHODS A prospective cohort study was conducted analyzing outcomes from 56 women with pregestational and 82 with gestational diabetes treated with either insulin regimen. RESULTS Comparisons were performed among 138 women: 56 with pregestational and 82 with gestational diabetes. In relation to maternal complications, worsening of retinopathy and nephropathy, preeclampsia, micro and macroalbuminuria, and all kinds of hypoglycemia were found higher in women with pregestational diabetes NPH-treated vs. glargine-treated. In women with gestational diabetes NPH-treated, it was observed increased incidence of prepregnancy and new-onset pregnancy hypertension, micro and macroalbuminuria, as well as mild and frequent hypoglycemia, compared to glargine-treated. Among the neonatal outcomes, 1-min Apgar score <7, necessity of intensive care unit and fetal death in pregestational, while jaundice and congenital malformations in gestational diabetes, respectively, were more frequently observed in infants born to NPH-treated, compared to glargine-treated. CONCLUSIONS Glargine use during pregnancy from preconception through delivery, showed to be safe since it is associated with decreased maternal and neonatal adverse outcomes compared with NPH insulin-treated patients.
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Aydin Y, Berker D, Direktör N, Ustün I, Tütüncü YA, Işik S, Delibaşi T, Guler S. Is insulin lispro safe in pregnant women: Does it cause any adverse outcomes on infants or mothers? Diabetes Res Clin Pract 2008; 80:444-8. [PMID: 18359121 DOI: 10.1016/j.diabres.2008.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 02/02/2008] [Indexed: 11/20/2022]
Abstract
AIM To determine the rate of major congenital anomalies and complications retrospectively in offspring of women with diabetes mellitus treated insulin lispro. MATERIAL AND METHODS Twenty-seven patients had used insulin lispro (ILYS) and 59 patients had used regular human insulin (RHI) during the pregnancy period were evaluated. We also evaluated and analyzed the results of 53 of the 86 women who had gestational diabetes mellitus only. They were not using insulin aspart or insulin glarjine. We evaluated the birth weight, congenital anamolies, mode of delivery, abortus and stillbirth rates. RESULTS Mean HbA1c level was 6.27+2.23 for ILYS group and 7.07+2.09 for RHI group (p: 0.067). The duration of diabetes, gestational age, mode of delivery, type of diabetes, number of liveborn, stillbirth and miscarriages were not stastically different between all groups (p>0.05). Nine (15.25%) of 59 infants treated with RHI had congenital anomalies and one stillborn. The infants in ILYS-receiving group had no congenital anomalies but one pregnant (3.70%) had a stillborn. The difference in incidence of congenital anomalies between those using ILYS and RHI was not statistically significant (p: 0.157). There was also no difference in respect to congenital anomalies of gestational diabetic groups which used either ILYS or RHI. CONCLUSION Major congenital anomalies for offspring of mothers treated with ILYS are similar with RHI group. Although HbA1c levels were lower in ILYS group, all outcomes are similar with RHI. So ILYS is an alternative choice in treatment of pregnant women with DM.
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Affiliation(s)
- Yusuf Aydin
- Ankara Numune Education and Research Hospital, Department of Endocrinology and Metabolism, 06610 Ankara, Turkey.
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Golbert A, Campos MAA. Diabetes melito tipo 1 e gestação. ACTA ACUST UNITED AC 2008; 52:307-14. [DOI: 10.1590/s0004-27302008000200018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 02/08/2008] [Indexed: 11/22/2022]
Abstract
As gestações em mulheres com diabetes têm apresentado resultados que melhoraram dramaticamente nas últimas décadas, em razão dos progressos com a monitorização das glicemias e administração de insulina. A gravidez nas mulheres com diabetes tipo 1 está associada a aumento de risco tanto para o feto quanto para a mãe. Antes da concepção, a prioridade é normalizar a glicemia para prevenir malformações congênitas e abortamentos espontâneos. Com o progresso da gestação, a mãe tem um risco aumentado de hipoglicemias e cetoacidose. Mais tarde existe risco de piora na retinopatia, hipertensão induzida pela gestação, pré-eclâmpsia-eclâmpsia, infecções de trato urinário e poliidrâmnios. No final da gestação, existe o risco de macrossomia e morte súbita intra-uterina do feto. Todas essas complicações podem ser prevenidas ou, pelo menos, minimizadas pelo planejamento da gestação e pelo controle intensivo das oscilações das glicemias, mantendo-as próximo ao normal.
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Affiliation(s)
- Airton Golbert
- Universidade Federal de Ciências da Saúde de Porto Alegre; Ministério da Saúde, Brasil
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Zeck W, Panzitt T, Schlembach D, Lang U, McIntyre D. Management of diabetes in pregnancy: comparison of guidelines with current practice at Austrian and Australian obstetric center. Croat Med J 2008; 48:831-41. [PMID: 18074418 DOI: 10.3325/cmj.2007.6.831] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To compare Austrian and Australian national guidelines for gestational and pre-gestational diabetes and estimate the level to which physicians comply with their country's guidelines. METHODS Austrian (ODG, Austrian Diabetes Society) and Australian guidelines (ADIPS, Australasian Diabetes in Pregnancy Society) for the treatment of gestational diabetes and pre-gestational diabetes were systematically reviewed. Current practices in two obstetric centers in Austria and Australia were assessed by interviewing key stakeholders through questionnaires assessing different components of diabetes care. For gestational diabetes, these components were screening, abnormal oral glucose tolerance test values (mmol/L), abnormal values for diagnosis, further management when abnormal values are detected, monitoring/glucose targets (mmol/L), further management and indications for insulin therapy, route and timing of delivery, and postpartum management and counseling. For pre-gestational diabetes, the components were management during the preconceptional period, glucose target values, medical surveillance, obstetric surveillance, medication used, route and timing of delivery, and postpartum management and counseling. RESULTS More variation was found in the management of gestational than pre-gestational diabetes. There were differences in oral glucose tolerance test and cut-off levels for diagnosing gestational diabetes in both centers and guidelines. Australian guidelines recommended two-stage screening for gestational diabetes, while Austrian guidelines recommended one-stage screening. At the Austrian obstetric center, amniocentesis was recommended for determining the start of insulin treatment in pregnant women with gestational diabetes. This approach was neither used at the Australian obstetric center nor recommended by any of the two guidelines. CONCLUSION Our study showed that it was difficult to standardize screening criteria and diagnostic methods for gestational and pre-gestational diabetes. National and international consensus has yet to be achieved in the management of diabetes in pregnancy.
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Affiliation(s)
- Willibald Zeck
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, A-8036, Graz, Austria.
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Cutchie WA, Cheung NW, Simmons D. Comparison of international and New Zealand guidelines for the care of pregnant women with diabetes. Diabet Med 2006; 23:460-8. [PMID: 16681554 DOI: 10.1111/j.1464-5491.2006.01850.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare international guidelines for the care of women with diabetes and pregnancy with reported current practice among New Zealand tertiary centres. RESEARCH DESIGN AND METHODS A literature review of national and international guidelines for the care of women with diabetes in pregnancy was undertaken. Guideline activities were placed within nine facets of care, from preconception advice, through pregnancy from screening to follow-up. New Zealand tertiary centres guidelines were obtained and placed in the same framework. RESULTS International guideline consensus was inconsistent across most facets of care. Those for the detection and diagnosis of gestational diabetes mellitus (GDM) were particularly discordant internationally, although intranational agreement has occurred. CONCLUSIONS International guidelines for the care of women with diabetes in pregnancy remain fragmented. The development of one set of guidelines based on the consensus of international best practice could overcome many of the misconceptions associated with diabetes in pregnancy.
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Affiliation(s)
- W A Cutchie
- Centre for Diabetes and Endocrinology Research, Westmead Hospital, Sydney, NSW, Australia
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González C, Santoro S, Salzberg S, Di Girolamo G, Alvariñas J. Insulin analogue therapy in pregnancies complicated by diabetes mellitus. Expert Opin Pharmacother 2006; 6:735-42. [PMID: 15934900 DOI: 10.1517/14656566.6.5.735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Pregnancies complicated by diabetes mellitus (DM) include pregestational DM and gestational DM, defined as carbohydrate intolerance of variable severity first detected during pregnancy. DM leads to poor pregnancy outcome. The aim of treatment is to control maternal hyperglycaemia and to imitate postprandial insulin release. Rapid-acting insulin analogues are suitable therapeutic candidates, as they are able to reduce postprandial hyperglycaemia (predictive of adverse pregnancy outcome). There is no excess risk of adverse fetal or maternal outcomes when compared with regular insulin. Data suggest that rapid-acting insulin analogues do not transfer to human placenta. Because of the reduced risk of hypoglycaemia and improved postprandial and overall glucose control, insulin analogues could be considered the rapid-acting insulin choice during pregnancy.
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Affiliation(s)
- Claudio González
- Pharmacology Department, Universidad de Buenos Aires, School of Medicine, Argentina
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McElduff A, Cheung NW, McIntyre HD, Lagström JA, Walters BNJ, Oats JJN, Wein P, Ross GP, Simmons D. The Australasian Diabetes in Pregnancy Society consensus guidelines for the management of type 1 and type 2 diabetes in relation to pregnancy. Med J Aust 2005. [DOI: 10.5694/j.1326-5377.2005.tb07087.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Aidan McElduff
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW
| | - N Wah Cheung
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW
| | - H David McIntyre
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW
| | - Janet A Lagström
- Centre for Diabetes and Endocrinology Research, Westmead Hospital, Westmead, NSW
| | | | | | - Peter Wein
- Department of Obstetrics, Royal Women's Hospital, Melbourne, VIC
| | - Glynis P Ross
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW
| | - David Simmons
- Waikato Clinical School, University of Auckland, Waikato Hospital, Hamilton, New Zealand
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Abstract
This article reviews normal and abnormal carbohydrate metabolism in pregnancy, with an emphasis on the challenges that are faced by those who care for the pregnant woman who has hyperglycemia. The growing problem of type 2 diabetes in pregnancy, the controversial use of oral antihyperglycemic agents for the treatment of gestational diabetes, and the long-term issue of diabetes prevention in those whose hyperglycemia resolves postpartum are also addressed.
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Affiliation(s)
- France Galerneau
- Yale University School of Medicine, Department of Obstetrics and Gynecology, 333 Cedar Street, P.O. Box 208063, New Haven, CT 06520-8063, USA
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Ben-Haroush A, Yogev Y, Chen R, Rosenn B, Hod M, Langer O. The postprandial glucose profile in the diabetic pregnancy. Am J Obstet Gynecol 2004; 191:576-81. [PMID: 15343240 DOI: 10.1016/j.ajog.2004.01.055] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE A controversy exists regarding the time to monitor blood glucose in the diabetic pregnancy (60 or 120 minutes after meals). Using a novel approach that provides continuous measurement of blood glucose, we sought to determine postprandial glucose profile in the diabetic pregnancy. STUDY DESIGN Subjects were connected to a continuous glucose monitoring system for 72 consecutive hours. A continuous glucose monitoring system measures the interstitial glucose levels in subcutaneous tissue every 5 minutes. Women were instructed to record the time of each meal during the study period. For each meal, the first 240 minutes were analyzed. RESULTS Sixty-five women participated in the study: 26 women were treated by diet alone; 19 women received insulin therapy, and 20 women had type 1 diabetes mellitus. The time interval from meal to peak postprandial glucose levels was similar in all the evaluated types of diabetic pregnancies and in good and poor control insulin-treated patients with gestational diabetes mellitus (approximately 90 minutes). Failure to return to preprandial glucose values within a 3-hour observation period was identified in approximately 50% of the patients. A similar postprandial glucose peak time was obtained for breakfast, lunch, and dinner in all study groups. Postprandial hypoglycemia events were noted in approximately 10% of the meals and occurred about 160 minutes after mealtime. CONCLUSION The time interval for postprandial glucose peak in diabetic pregnancies is approximately 90 minutes after meals throughout the day and is not affected by the level of glycemic control. This information should be considered in the treatment of diabetes mellitus in pregnancy.
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Affiliation(s)
- Avi Ben-Haroush
- Department of Obstetrics and Gynecology, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
OBJECTIVE The role of maternal hypoglycemia during pregnancy has not yet been established. We sought to estimate the prevalence of undiagnosed, asymptomatic hypoglycemic events that occur in diabetic patients. METHODS All patients were evaluated using a continuous glucose monitoring system for 72 consecutive hours. The continuous glucose monitoring system measures in subcutaneous tissue interstitial glucose levels within a range of 40-400 mg/dL every 5 minutes for a total of 288 measurements per day. All patients were instructed regarding diabetic diet and assigned to pharmacological treatment as needed. Patients documented the time of food intake, insulin or glyburide administration, and all clinical hypoglycemic events. An asymptomatic hypoglycemic episode was defined as more than 30 consecutive minutes of glucose value below 50 mg/dL detected only by continuous glucose monitoring system reading without patient awareness. RESULTS An evaluation of 82 patients with gestational diabetes was performed; 30 were insulin-treated, 27 were managed by diet only, and 25 were patients treated with glyburide. For purposes of comparison, data were obtained from 35 nondiabetic gravid women. Asymptomatic hypoglycemic events were identified in 19 of 30 (63%) insulin-treated patients and in 7 of 25 (28%) glyburide-treated patients. No hypoglycemic events were identified in patients with gestational diabetes mellitus treated by diet alone or in nondiabetic subjects. The mean recorded hypoglycemic episodes per day was significantly higher in insulin-treated patients (4.2 +/- 2.1) than in glyburide-treated patients (2.1 +/- 1.1), P =.03. In insulin-treated patients, the majority of the hypoglycemic events were nocturnal (84%), whereas in glyburide-treated patients, episodes were identified equally by day and night. CONCLUSION Our data suggest that asymptomatic hypoglycemic events are common during pharmacological treatment in gestational diabetic pregnancies. We speculate that this finding may be explained by treatment modality rather than by the disease itself.
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Affiliation(s)
- Yariv Yogev
- Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital Center, University Hospital of Columbia University, New York, New York 10019, USA.
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