399 Simple basal insulin regimen in women with mild gestational diabetes

Abstract

Approximately 30% to 40% of women with gestational diabetes (GDM) receive insulin therapy, and the multiple daily insulin injection (MDI) regimen with a combination of basal and prandial insulin is generally used, as in cases of prepregnancy diabetes. We developed a simple insulin injection (SII) regimen, in which one or two injected doses of basal insulin are used, for women with mild GDM who require insulin therapy. The present study explored whether or not the SII regimen is as effective as the MDI regimen in preventing fetal macrosomia in women with mild GDM. In this retrospective study, we included singleton pregnant women with GDM in a tertiary perinatal care center. Insulin therapy was indicated if glucose control did not reach the target values under diet therapy. At the beginning of the insulin therapy, we used one daily injection of NPH insulin (10 to 20 units) before breakfast and added another injection of NPH insulin at bedtime, if necessary. If the control still did not reach the target values, we switched to an MDI regimen with additional prandial insulin aspart injection. We compared the glucose control levels, gestational weight gain (GWG), and perinatal outcomes between the diet-alone, SII, and MDI groups. Among 397 women with GDM, 66%, 15%, and 19% were in the diet-alone, SII, and MDI groups, respectively. There were no significant differences in the glucose control, maternal GWG, or perinatal outcomes among the groups (Table). Among the 34% of women with GDM requiring insulin therapy, 44% had a well-controlled condition with the SII regimen without any increase in the GWG or adverse perinatal outcomes. In women with mild GDM requiring insulin therapy, nearly half can maintain good control with this simpler insulin regimen.