Issue 135 Item 14 Glycemic Control in Pregnant Women with Insulin Lispro

Insulin lispro is effective as regular short-acting insulin in controlling blood glucose in pregnant women with type 1 diabetes. A group of researchers led by Dr Persson from Karolinska Hospital in Stockholm, Sweden, compared the effects of rapid-acting insulin lispro with regular short-acting insulin on glycemic control in 33 pregnant women with type 1 diabetes. Concentrations of blood glucose and HbA1c were monitored six times daily and every 4 weeks, respectively. The women were evaluated at gestational week 14 and then during the study period at weeks 21, 28 and 34.

The researchers showed that blood glucose concentrations were lower after breakfast in the insulin lispro group (p<0.01). The reductions in HbA1c concentrations were similar in both treatment groups. Two women in the insulin group had severe hypoglycemia, but biochemical hypoglycemia, defined as a blood glucose concentration <3.0mmol/L, occurred more frequently in the insulin lispro group than in the insulin group (5.5% vs 3.9%, respectively). Retinopathy progressed in both groups and one woman in the insulin group developed proliferative retinopathy. The number of complications during pregnancy, route of delivery and fetal outcomes were the same in both groups. There was no perinatal mortality. The researchers conclude that insulin lispro provides at least as effective glycemic control as regular short-acting insulin in pregnant women with type 1 diabetes. Diabetes Research and Clinical Practice 2002;58:115-21