Comparing twice versus four times daily insulin in mothers with gestational diabetes in Pakistan and its implications

Nazish Saleem, Brian Godman, Shahzad Hussain

Research output: Contribution to journalArticle

Abstract

Background: Gestational diabetes mellitus (GDM) is a common medical problem associated with maternal and fetal complications. Good glycaemic control is the cornerstone of treatment. Objective: Compare outcomes between four times (4x) and twice daily (2x) regimens. The morning dose of the 2x regimen contained two thirds of the total insulin comprising one third human regular insulin and two thirds human intermediate insulin; equal amounts in the evening. Methods: 480 women at > 30 weeks with GDM with failure to control blood glucose randomly assigned to either regimen. Results: Mean time to control of blood glucose significantly less and glycaemic control significantly increased with 4x regimen. Operative deliveries, extent of neonatal hypoglycaemia, babies with low Agpar scores and those with hyperbilirubinaemia significantly higher in 2x daily regimen. Conclusion: 4x daily regime associated with improved fetal and maternal outcomes. Consequently should increasingly be used in Pakistan, assisted by lower acquisition costs
LanguageEnglish
JournalJournal of Comparative Effectiveness Research
Publication statusAccepted/In press - 12 May 2016

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Gestational Diabetes
Pakistan
Blood Glucose
Insulin, Regular, Human
Mothers
Insulin
Hyperbilirubinemia
Hypoglycemia
Costs and Cost Analysis
Therapeutics

Keywords

  • gestational age
  • insulin
  • gestational diabetes
  • Pakistan

Cite this

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AB - Background: Gestational diabetes mellitus (GDM) is a common medical problem associated with maternal and fetal complications. Good glycaemic control is the cornerstone of treatment. Objective: Compare outcomes between four times (4x) and twice daily (2x) regimens. The morning dose of the 2x regimen contained two thirds of the total insulin comprising one third human regular insulin and two thirds human intermediate insulin; equal amounts in the evening. Methods: 480 women at > 30 weeks with GDM with failure to control blood glucose randomly assigned to either regimen. Results: Mean time to control of blood glucose significantly less and glycaemic control significantly increased with 4x regimen. Operative deliveries, extent of neonatal hypoglycaemia, babies with low Agpar scores and those with hyperbilirubinaemia significantly higher in 2x daily regimen. Conclusion: 4x daily regime associated with improved fetal and maternal outcomes. Consequently should increasingly be used in Pakistan, assisted by lower acquisition costs

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