954-P: In Gestational Diabetes, Patient-Led Insulin Titration Is Rapidly Effective without Detrimental Hypoglycaemia

Abstract

Introduction: Elevated fasting blood glucose in gestational diabetes (GDM) is the strongest predictor of adverse pregnancy outcomes but is difficult to treat. We assessed the effectiveness and safety of a novel patient-led insulin dose titration algorithm, targeting rapid reduction in fasting glucose. Research Design and Methods: In women with GDM commenced on insulin, we initiated a patient-led approach to basal dose titration. Women were asked to increase their basal insulin dose by 4 units after every elevated fasting blood glucose (>90 mg/dL). We retrospectively reviewed the records of 50 women with GDM, after initiating this approach. Daily fasting capillary glucose measurements and insulin dose were collected from GDM diagnosis to delivery. Results: Basal insulin was commenced at a median 30+4 weeks gestation in 28 (56%) women. At insulin initiation median fasting glucose was 104.4 mg/dL. Fasting glucose control (defined as the first of three consecutive readings <95 mg/dL) was achieved by all women after a median 4 days (IQR: 1-13). This was successfully maintained for the remainder of pregnancy with additional patient-led titrations. Basal insulin dose at delivery (median 38+2 weeks gestation) was a median 34 units (IQR 18-62; 0.31 units/kg; IQR 0.23-0.71) with a birthweight less than half a standard deviation above normal (birthweight z-score 0.47 vs. 0.81 [n=34 insulin treated prior to implementation]). Hypoglycaemia <63 mg/dL was uncommon in those on basal insulin (1.86% of all fasting glucose readings) with just five values <54 mg/dL (0.34% of all readings). By comparison, in women never started on basal insulin (n=22), 0.45% of fasting readings were <63 mg/dL with just one value <54 mg/dL (0.09% of all readings). No patients experienced hypoglycaemia requiring assistance. Conclusions: In GDM, fasting glycaemic control is achieved within a week by using intensive patient-led insulin titration and is not at the expense of detrimental hypoglycaemia. Disclosure I. K. Mayne: None. N. Thomas: None. A. T. Hattersley: None. A. P. Mcgovern: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc.