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Efficacy and safety of the pregnancy‐IVI, an intravenous insulin protocol for pregnancy, following antenatal betamethasone in type 1 and type 2 diabetes
Author(s) -
Rowe Christopher W.,
Watkins Brendan,
Brown Karina,
Delbridge Matthew,
Addley Jordan,
Woods Andrew,
Wynne Katie
Publication year - 2021
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.14489
Subject(s) - medicine , pregnancy , type 2 diabetes , diabetes mellitus , gestational diabetes , betamethasone , obstetrics , type 1 diabetes , gestation , endocrinology , genetics , biology
Aims Hyperglycaemia following antenatal corticosteroids is common in women with diabetes in pregnancy, and validated algorithms to maintain pregnancy‐specific glucose targets are lacking. The Pregnancy‐IVI, an intravenous‐insulin (IVI) algorithm, has been validated in gestational diabetes; however, its performance in pre‐existing diabetes (Type 1 and Type 2 diabetes) is not known. We hypothesised that Pregnancy‐IVI would be superior to a generic Adult‐IVI protocol (prior standard of care) following betamethasone in women with pre‐existing diabetes. Methods A retrospective cohort study enrolled all women with pre‐existing diabetes at a tertiary centre receiving betamethasone and treated with IVI according to one of two protocols: Adult‐IVI (n = 73, 2014–2017) or Pregnancy‐IVI (n = 62, 2017–2020). The primary outcome was on‐IVI glycaemic time‐in‐range (capillary blood glucose (BGL) 3.8–7.0 mmol/L). Secondary outcomes included time with critical hyperglycaemia (BGL > 10 mmol/L); occurrence of maternal hypoglycaemia (BGL < 3.8 mmol/l) and incidence of neonatal hypoglycaemia (BGL ≤ 2.5 mmol/L). Analysis was stratified by diabetes type. Results Overall, Pregnancy‐IVI achieved a higher proportion of on‐IVI time‐in‐range (70%, IQR 56–78%) compared to Adult‐IVI (52%, IQR 41–69%, p < 0.0001). The duration of critical hyperglycaemia with Pregnancy‐IVI was also reduced (2% [IQR 0–7] vs 8% [IQR 4–17], p < 0.0001), without an increase in hypoglycaemia. Glycaemic variability was significantly reduced with Pregnancy‐IVI. No difference in the rate of neonatal hypoglycaemia was observed. The Pregnancy‐IVI was most effective in women with Type 1 diabetes. Conclusion The Pregnancy‐IVI algorithm is safe and effective when used following betamethasone in type 1 diabetes in pregnancy. Further study of women with type 2 diabetes is required.