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Impact of two treatment regimens with insulin lispro on post-prandial glucose excursion patterns and fetal fat mass growth in type 1 diabetic pregnant women

      Objective

      To compare glycemic control, post-prandial glucose excursion patterns, and growth rate of fetal fat mass in type 1 diabetic pregnancies treated with continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injection (MDI), to that in normal pregnancies.

      Study design

      71 women with type 1 diabetes enrolled within 10 weeks gestation were randomly assigned to CSII insulin lispro (n=35) or MDI pre-meal bolus insulin lispro (n=36). The women were matched 1:2 with 142 non diabetic pregnancies enrolled within 12 weeks of gestation who performed daily glucose profiles fortnightly from 16 to 38 weeks gestation.
      Ultrasound scans were performed fortnightly in the period from 25 to 38 weeks gestation to assess the growth of fetal fat mass (anterior abdominal thickness and mid-thigh subcutaneous areas). The post prandial glucose excursions were calculated as areas under the curves at 0 to 1, 1 to 2, 2 to 4 and 0 to 4 hours in the 3 meal (breakfast, lunch and dinner) post-prandial area.

      Results

      There were no differences between CSII and MDI groups with respect to average daily glucose levels throughout gestation. At 16, 26, and 36 weeks the pattern of 24-hr glycemic profiles of the CSII group was similar to the normal group, whereas the pattern of the MDI group showed a significantly longer time period in the three meal post-prandial areas (p<0.001). Fetuses of MDI group had a significantly higher growth rate of fat deposition in the abdomen and in the mid-thigh (p=0.0088 and p=0.0073) in the period from 25 to 38 weeks. In contrast, in the CSII group, fetal growth was similar to that in the control.

      Conclusion

      In type 1 diabetic pregnant women, insulin lispro, administered as a CSII regimen, was found to mimic more closely the normal post prandial glucose excursion pattern, as well as to achieve fetal fat mass growth pattern that are similar those of normal pregnancy.