The utility and efficacy of the new insulins in the management of diabetes and pregnancy

Abstract

The quest for tight glucose control has led to the development of insulin analogues (insulin lispro, insulin aspart, insulin glargine) designed to optimize glucose control while minimizing the impact of insulin therapy on daily life. Women with diabetes are increasingly likely to become pregnant on these new products and to benefit from their use while pregnant. Caution over the use of new medications in pregnancy has limited experience, but increasing evidence is emerging that use of insulin lispro is not associated with excess risk of fetal malformations, is associated with similar or better outcomes during pregnancy, and is preferred over regular insulin. Similar evidence for the other insulin analogues has yet to emerge, but is unlikely to be dissimilar.

Management of Diabetes in Pregnancy: Comparison of Guidelines with Current Practice at Austrian and Australian Obstetric Center

“…Insulin analogues are increasingly used instead of human insulin. Although evidence is emerging that the use of insulin analogues is not associated with excess risk of fetal malformations (26), there are still no recommendations from any guidelines. Metformin is sometimes used at the Australian obstetric center in Type 2 diabetes only; however a randomized trial involving metformin (MiG study) is under way (27).…”

Insulin analogue therapy in pregnancies complicated by diabetes mellitus

“…Due to the facts mentioned in the previous paragraphs, the main goal of treatment would be to control maternal hyperglycaemia periconceptually and to imitate postprandial insulin release, tailoring insulin action in special situations, such as physical activity or intercurrent disease, in order to reduce the incidence of diabetes in pregnancy related complications [14].…”

“…A target haemoglobin A1c less than the population mean + 3 SDs is accepted, although euglycaemia is ideal. The guidelines also counsel preprandial levels of 3.9 -5.3 mmol/l and 1-and 2-h postprandial levels of < 7.8 and 6.7 mmol/l, respectively, during the complete pregnancy [14].…”

“…With the introduction of short-acting insulin analogues these aims would become more achievable [27] as they would be more able to reduce postprandial hyperglycaemia, understood to be more predictive of adverse outcomes than fasting glycaemia [14]. Thus, in some studies, women treated with insulin lispro were reported to achieve a lower glycated haemoglobin predelivery and fewer severe hypoglycaemic episodes than those treated with regular insulin [14].…”

“…Thus, in some studies, women treated with insulin lispro were reported to achieve a lower glycated haemoglobin predelivery and fewer severe hypoglycaemic episodes than those treated with regular insulin [14]. Jovanovic et al, described that in their randomised trial using shortinsulin analogues for GDM, women under treatment with insulin lispro had significantly lower glucose excursions after a test meal.…”