In gestational diabetes, patient‐led insulin titration is rapidly effective, safe and is associated with reduced birthweight. (2nd August 2022)

• Record Type: Journal Article
• Authors: Mayne, Isabelle K; Rawdon, Emma; Guerin, Emma; McGovern, Andrew P
• Is Part Of: Practical diabetes. Volume 39:Number 4(2022)
• Page Start: 26
• Page End: 31
• Publication Date: 2022-08-02
• Subjects: diabetes, gestational -- insulin -- blood glucose -- hyperglycaemia -- self‐management -- algorithms -- birth weight; Diabetes -- Treatment -- Periodicals; Medical protocols -- Periodicals; 616.46206
• DOI: 10.1002/pdi.2407
• Languages: English
• ISSNs: 2047-2897

Abstract

Abstract: Background: Elevated fasting glucose in gestational diabetes (GDM) is the strongest predictor of adverse pregnancy outcomes but is difficult to treat. We assessed the effectiveness, safety, and patient acceptability of a simple patient‐led insulin dose titration algorithm in GDM, targeting rapid reduction in fasting glucose. Methods: Once initiated on basal insulin, women were asked to increase their dose by 4 units daily, following every fasting glucose ≥5.0mmol/L. We evaluated pregnancy outcomes, rates of hypoglycaemia and time taken to achieve target readings (<5.3mmol/L) before and after this practice change. We undertook patient interviews and questionnaires to capture the patient perspective. Results: Insulin was commenced at a median 30+4 weeks with fasting glucose control (defined as the first of three consecutive readings <5.3mmol/L) achieved after a median 4 days (IQR: 1–11) and maintained throughout pregnancy with further patient‐led titrations. Hypoglycaemia was uncommon; 1.7% of all fasting glucose readings were <3.5mmol/L and 0.3% were <3.0mmol/L. No patients experienced hypoglycaemia requiring assistance. At delivery, patient‐led titration achieved higher final insulin doses (53 vs 36 units/day; p=0.027), improved fasting glucose (4.6 vs 5.1mmol/L; p=0.031), and significantly lower birthweight (Z‐scores 0.34 vs 0.92; p=0.005) compared to our previous routine practice. Women liked the intervention and having increased responsibility for their own management. Conclusions: In GDM significant reduction in birthweight is achieved with patient‐led insulin dose titration. Following insulin initiation glycaemic control is achieved rapidly and maintained without detrimental hypoglycaemia. Copyright © 2022 John Wiley & Sons.