Royal Devon and Exeter Hospital, Exeter, UK.
University of Exeter Medical School, Exeter, UK.
Diabet Med. 2022 Oct;39(10):e14926. doi: 10.1111/dme.14926. Epub 2022 Aug 8.
Elevated fasting blood glucose in gestational diabetes (GDM) is a key predictor of high birthweight babies and adverse pregnancy outcomes but is hard to treat. We implemented a simple, patient-led, insulin dose titration algorithm aiming to improve fasting glycaemic control in GDM.
In women with GDM, initiating basal insulin, we recommended a daily four-unit dose increase after every fasting glucose value ≥5.0 mmol/mol (90 mg/dl). This approach augmented our pre-existing intensive (weekly) specialist nursing input. Using a before-and-after retrospective observational study design, we examined insulin doses and glucose values at 36 weeks gestation and maternal and neonatal outcomes in 105 women completing pregnancy before and 93 women after the intervention.
The baseline characteristics of women in the before and after groups were the same. Women initiated on insulin after implementation (n = 30 before, n = 43 after) achieved substantially higher doses at 36 weeks (53 vs. 36 units/day; 0.56 vs. 0.37 units/kg/day; p = 0.027). 36-week mean fasting glucose was lower in those on insulin after implementation (4.6 vs. 5.1 mmol/L [83 vs. 92 mg/dl]; p = 0.031). Birthweight was significantly reduced (birthweight Z-scores 0.34 vs. 0.92; p = 0.005). There was no significant difference in macrosomia (after; 2% vs. before; 17% p = 0.078) or caesarean sections (after; 33% vs. before; 47%; p = 0.116). No women experienced severe hypoglycaemia. There were no outcome differences before versus after intervention in women not treated with insulin.
Patient-led daily insulin titration in gestational diabetes leads to higher insulin dose use lower fasting glucose and is associated with lower birthweight without causing significant hypoglycaemia.
妊娠期糖尿病（GDM）患者的空腹血糖升高是导致巨大儿和不良妊娠结局的关键预测因素，但很难治疗。我们实施了一种简单的、以患者为中心的胰岛素剂量滴定算法，旨在改善 GDM 的空腹血糖控制。
在 GDM 女性中，起始基础胰岛素时，我们建议在每次空腹血糖值≥5.0mmol/mol（90mg/dl）时，每日增加 4 个单位剂量。这种方法增加了我们现有的强化（每周）专科护士的投入。采用前后回顾性观察研究设计，我们检查了 105 名在干预前完成妊娠和 93 名在干预后完成妊娠的女性在 36 孕周时的胰岛素剂量和血糖值以及母婴结局。
前后两组女性的基线特征相同。在实施后开始使用胰岛素的女性（实施前 30 例，实施后 43 例）在 36 孕周时的胰岛素剂量显著更高（53 与 36 单位/天；0.56 与 0.37 单位/公斤/天；p=0.027）。实施后使用胰岛素的女性 36 周平均空腹血糖较低（4.6 与 5.1mmol/L[83 与 92mg/dl]；p=0.031）。出生体重显著降低（体重 Z 评分 0.34 与 0.92；p=0.005）。巨大儿的发生率没有显著差异（实施后 2%，实施前 17%；p=0.078）或剖宫产率（实施后 33%，实施前 47%；p=0.116）。没有女性发生严重低血糖。未接受胰岛素治疗的女性在干预前后的结局无差异。
妊娠期糖尿病患者主导的每日胰岛素滴定可导致更高的胰岛素剂量、更低的空腹血糖，且与低血糖无关，与降低出生体重相关。
