Background: Current guidelines from the American College of Obstetricians and Gynecologists recommend
insulin as the standard
therapy for treatment of pregestational and
gestational diabetes (PGDM and GDM). However, the guidelines do not specify which type(s) of
insulin to utilize. Additionally, there are limited published data regarding safety parameters of
insulin in this population. Objective: To evaluate if
insulin glargine or detemir (
long-acting insulin) results in less
hypoglycemia, hospitalizations, or delivery complications compared with intermediate-acting
insulin neutral protamine Hagedorn (NPH) in PGDM and GDM. Methods: This single-center, retrospective, observational cohort study included pregnant women who were 18 years or older with PGDM or GDM and received
insulin therapy during pregnancy at an outpatient obstetric clinic. The primary outcome was the frequency of
hypoglycemia (BG < 60 mg/dL). Secondary outcomes included emergency department visits and hospitalizations, delivery complications, and the duration of time at glycemic targets during pregnancy. Results: A total of 63 patients were included for evaluation. There was no significant difference in the frequency of
hypoglycemia between the long-acting and NPH groups (4.4 vs 6.2 events per patient, respectively; P = 0.361). Patients receiving
long-acting insulin had significantly more encounters with diabetes education (10.6 vs 5.1 visits per patient, P = 0.002) and more consistently provided
glucose readings at their appointments (8.3 vs 4.8, P = 0.043). There was no difference in hospitalizations or maternal and neonatal complications. Conclusion and Relevance: Long-acting
insulins did not reduce the frequency of
hypoglycemia compared with NPH. The results of this study confirm the need for additional investigations with larger populations.