Computerized insulin protocol for intrapartum and postpartum glucose management in gravidas with Type 1 diabetes

Abstract

Computerized insulin infusion calculators (IICC) improve glucose control in non-pregnant populations. Our IICC is an insulin sensitivity coefficient-based algorithm relying on point of care (POC) glucose values and the rate of change which allows for dynamic changes in insulin resistance. We evaluated the effectiveness of an IICC in achieving intrapartum and postpartum euglycemia in gravidas with Type 1 diabetes mellitus (T1DM). This retrospective study included gravidas with T1DM managed intrapartum and postpartum with IICC between 2016-2020. Patients were excluded if insulin infusion or POC glucose values were not available. Insulin infusion rate, POC glucose and neonatal data were obtained from the electronic medical record. Our primary outcome was the percentage of hourly glucose values within goal in the intrapartum period (80-119 mg/dL), and postpartum period (80-179 mg/dL). Secondary outcomes included intrapartum mild hyperglycemia (120-179 mg/dL) and hypoglycemia (< 60 mg/dL), hyperglycemia (≥ 180 mg/dL) for both time periods, and select neonatal outcomes. 39 patients (47 pregnancies) were included for analysis. Mean maternal age was 29.5 ± 5.3 years and first trimester HbA1c was 7.2 ± 1.4%. 39.3% (n=471) of the intrapartum glucose values and 68.7% (n=929) of the postpartum glucose values were in target (p< .0001)(Figure 1). The incidence of intrapartum mild hyperglycemia was 545 (46.3%). The incidence of hypoglycemia was 2.7% for both time periods while the incidence of hyperglycemia was 9.3% and 18.6% intrapartum and postpartum, respectively. Figure 2 shows the mean POC glucose values. Twenty-four (51.1%) neonates were admitted to the neonatal intensive care unit and 22 (46.8%) had hypoglycemia requiring dextrose infusion. To our knowledge, this is the first descriptive study of IICC use intrapartum and postpartum. The IICC performed better at achieving postpartum versus intrapartum glucose control, while having low rates of hyperglycemia and hypoglycemia. Development of a pregnancy specific IICC may improve peripartum glycemic control.View Large Image Figure ViewerDownload Hi-res image Download (PPT)