DOES INSULIN FORMULATION MATTER IN ANTENATAL DIABETES CARE?
J Kumar, K Baynes, S Pender, C Lowy, R Jones & P Carroll
Aim: To assess usage of newly available rapid-acting insulin analogues in the antenatal diabetes clinic, and to determine whether introduction of these agents has influenced glycaemic control.
Methods: We analysed our diabetes antenatal clinic attendances from April 2002 to June 2003 using the DIABETA 3 database. 290 pregnant women were seen over this period which was divided into three groups: Group I (April to September 2002), Group II (October 2002 to March 2003) and Group III (April 2003 to June 2003). Gestational diabetes mellitus was diagnosed on a 75 grams Oral Glucose Tolerance Test (plasma glucose fasting greater than/equal to 7.0 millimols per litre and/or 2 hour greater than/equal to 9 millimols per litre). The three groups were compared with respect to type of insulin used, insulin regimen and last recorded fructosamine values.
Results: Use of analogue/analogue-mix insulins increased significantly compared to soluble/mixed insulins from Group I to III (p less than 0.001). Simultaneously use of basal-bolus regimens increased (50, 66 and 71 percent of patients, Groups I, II and III, respectively) with a corresponding fall in the use of pre-mixed insulin regimens (p less than 0.01, Groups I vs III). Fructosamine values were similar in each group (Group I: 215 plus/minus 28; II: 220 plus/minus 43; III: 222 plus/minus 34 micromols/litre; Mean plus/minus SD) and also between the regimen used (basal-bolus: 215 plus/minus 37; pre-mixed: 225 plus/minus 32.5 litre/litre; Mean plus/minus SD).
Conclusions: Use of analogue insulins and basal bolus regimens have significantly increased over the past fifteen months in our antenatal diabetes service, however, the degree of effective control of diabetes has not significantly changed. Further analysis will address the impact of these analogues on frequency and severity of hypoglycaemia and foetal and maternal outcome.