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402: Basal insulin analogs versus neutral protamine hagedorn for type 2 diabetics

      Objective

      Based on data from non-pregnant women, American Diabetes Association (ADA) recommends long- acting basal analogs (glargine or detemir) be used instead of intermediate-acting insulin (neutral protamine hagedorn [NPH]) to reduce adverse outcomes in type 2 diabetic (T2DM) (Diabetes Care, 2018). However, in pregnant women with T2DM there is a paucity of reports focused exclusively on T2DM. The aim of this study was to compare whether basal insulin analogs reduces rate of composite neonatal morbidity (CNM) and maternal adverse outcomes compared to NPH in women with T2DM.

      Study Design

      A retrospective cohort study of all women with T2DM and singleton pregnancy (March 2012 to May 2018) managed at a single tertiary center. Exclusion criteria were known major anomalies, diabetic nephropathy or proliferative retinopathy. The primary outcome was a CNM of any of the following: large for gestational age, shoulder dystocia, NICU admission, hypoglycemia (BS< 40 mg/dL in the first 24 hours of life or <50 mg/dL after 24 hours or requiring medical therapy) or RDS. Secondary outcomes were rates of maternal hypoglycemia events, hypertensive disorders, admission for glucose control, preterm birth (< 37 wks) and primary cesarean delivery. Adjusted relative risk (aRR) and 95% confidence intervals (CI) were calculated.

      Results

      Of 233 women with T2DM, 114 (49%) were treated with basal insulin analogs and 119 (51%) with NPH. Table 1 compares demographic and clinical characteristics. Significant differences on univariate analysis are bolded. The rate of CNM was similar between groups (73% vs 60%, aRR 1.16, 95% CI 0.90-1.49). Basal insulin treatment was associated with a lower risk for a primary cesarean delivery compared to NPH (21% vs 36%, aRR 0.43; 95% CI 0.24- 0.76). There were no differences in the rates of maternal hypoglycemic events, admission for glucose control, preeclampsia or preterm birth between the groups (Table2).

      Conclusion

      The rate of CNM, neonatal or maternal hypoglycemia—were similar for T2DM managed with either basal or NPH insulin regimen. Since this is a retrospective study, a randomized trial enrolling patients with T2DM prior to 20 weeks of gestation and comparing short and long-term maternal and neonatal outcomes between the two treatment regimens is warranted.
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