Olfa Berriche, Haifa Sfar, Faten Mahjoub, Emna Fenira, Rym Ben othmen, Imen Ksira, Amel Gamoudi, Chiraz Amrouche and Henda Jamoussi
Background: Pregnancy in diabetic women is at high-risk of maternal and fetal complications. Insulin which remains the main treatment during pregnancy is not devoid of adverse effects mainly hypoglycemia and weight gain. The objective of our study was to evaluate the efficiency and safety of insulin analogs compared to conventional insulin in a group of pregnant women with diabetes.
Methods: A prospective longitudinal study comparing two groups of diabetic pregnant women (including type 1(T1DM) and type 2 diabetes mellitus (T2DM)): group 1 (G1) made of 43 patients on conventional insulin and group 2 (G2) made of 30 patients on analogues. Patients were enrolled at a gestational age before 12 weeks and were followed until childbirth.
Results: At baseline, age, types of diabetes, duration of diabetes and average HbA1c at the first trimester were similar between treatment groups. Upon study of glycemic profiles, in the third trimester, the mean group 2 fasting plasma glucose (FPG) was lower compared to group 1(G1: 1.19 ± 0.32 g/l vs. G2: 1.05 ± 0.26 g/l; p=0.06). Mean evening pre-prandial glucose was although significantly higher in group 2 in the 1st and 2nd trimesters became comparable to that in group 1 in the 3rd quarter, indeed a significant improvement with insulin analogues was shown (p=0.042). The rest of the glycemic profile was comparable in both groups as well as HbA1c levels throughout pregnancy (HbA1c T3: G1: 6.7 ± 1.2 % vs. G2: 7.18 ± 1.1%; p=0.16). The episodes of nocturnal and severe hypoglycemia were similar in both groups. Weight gain was lower in G2 than in G1 but the difference was not significant (G1: 10.27 ± 5.46 kg versus G2: 7.69 ± 5.34 kg; p=0.082).
Conclusion: Our study showed that insulin analogs were not inferior to conventional insulin to achieve glycemic control during pregnancy.