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Gestational diabetes insulin protocol following betamethasone reduces neonatal hypoglycemia
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A pregnancy-specific IV insulin-glucose infusion protocol in gestational diabetes effectively controlled maternal hyperglycemia following betamethasone and also was associated with reducing betamethasone-associated neonatal hypoglycemia, according to findings presented at the Society for Endocrinology BES annual meeting.
Neonatal hypoglycemia is common in infants born soon after betamethasone administration and may be reduced by at-target, peripartum glycemic control, Christopher Rowe, MBBS, FRACP, an adult endocrinologist at the John Hunter Hospital and clinician-researcher at the University of Newcastle and the Hunter Medical Research Institute in New South Wales, Australia, and colleagues wrote in an abstract. In June 2017, researchers introduced a pregnancy-specific IV insulin-glucose infusion protocol, replacing a generic adult IV insulin protocol not designed for pregnancy. The infusion was initiated with any blood glucose level of at least 6.7 mmol/L following betamethasone and continued for 24 hours after the final dose of betamethasone. Capillary glucose levels were measured every 30 to 60 minutes during the infusion.
“The pregnancy-IVI, an insulin infusion designed specifically for gestational diabetes, provides more effective glycemic control following betamethasone than a generic adult insulin infusion,” Rowe told Endocrine Today. “On average, women spent 68% of on-infusion time with glucose within the pregnancy specific target of 3.8 to 7 mmol/L. This improvement in glycemic control is associated with a reduction in neonatal hypoglycemia. One case of neonatal hypoglycemia is prevented for every four women treated with the pregnancy-IVI.”
In a prospective audit conducted between June 2017 and May 2018, Rowe and colleagues analyzed data from women with gestational diabetes requiring betamethasone and receiving a pregnancy IV insulin infusion at John Hunter Hospital following betamethasone in women with gestational diabetes (n = 65) and compared data with a similar retrospective cohort treated with an adult IV insulin infusion not designed for pregnancy (n = 86). Primary outcome was percentage of on-infusion time at target, defined as a blood glucose level between 3.8 mmol/L and 7 mmol/L. Secondary outcomes were percentage of time with critical hyperglycemia, defined as a blood glucose of at least 10 mmol/L, or hypoglycemia, defined as a blood glucose less than 3.8 mmol/L. Researchers also assessed the incidence of neonatal hypoglycemia, defined as a blood glucose less than 2.7mmol/L in first 48 hours if betamethasone was given within 2 days of birth.
The researchers found that on-infusion time at target was 68% (95% CI, 64-71) for the pregnancy IV insulin infusion group vs. 55% (95% CI, 50-60) for those in the adult IV infusion group not designed for pregnancy (P = .0002).
Incidence of critical hyperglycemia was also lower with the pregnancy infusion vs. the adult infusion (2% vs. 5%; P = .006), with no change in rate of hypoglycemia (0.1% vs. 0.5%, respectively; P = .09).
Neonatal hypoglycemia occurred with 11 of 31 births (35%) after the pregnancy infusion, compared with 29 of 48 births (60%) after the adult infusion (P = .03). In a logistic regression model adjusted for confounders, the OR for neonatal hypoglycemia with the pregnancy IV insulin infusion was 0.3 (95% CI, 0.11-0.82).
“Neonatal hypoglycemia is common in women with gestational diabetes who deliver within 48 hours of [receiving] betamethasone, affecting the offspring of around one in two women,” Rowe said. “This study provides efficacy and safety data of a novel insulin infusion protocol, which is the first intervention shown to reduce this clinically important endpoint.”
The study is the first large-scale, real-world validation of an insulin-infusion protocol designed specifically for managing hyperglycemia following betamethasone in pregnancies complicated by gestational diabetes, according to Rowe, who added that it is important that the findings are reproduced in other settings.
“We would also like to see if the benefits seen in women with gestational diabetes are translatable to the setting of pre-existing diabetes, and this work is underway at John Hunter Hospital in Australia,” he said.
The findings were also published online recently in Diabetic Medicine. – by Regina Schaffer
References:
Rowe CW, et al. OC4.4. Presented at: Society for Endocrinology BES Annual Meeting; Nov. 19-21, 2018; Glasgow, U.K.
Rowe CW, et al. Diabet Med. 2018;doi:10.1111/dme.13864.
For more information:
Christopher Rowe, MBBS, FRACP, can be reached at John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia; email: christopher.rowe@hnehealth.nsw.gov.au.
Disclosures: The authors report no relevant financial disclosures.