Continuous Insulin Infusion Rated Superior


MIAMI BEACH — Continuous subcutaneous insulin lispro infusion appears to be superior to multiple daily insulin lispro injections for the treatment of pregnant women with type 1 diabetes, Dr. Giorgio Mello reported at the annual meeting of the Society for Maternal-Fetal Medicine.

In a randomized controlled study of 71 pregnant women with type 1 diabetes and 142 matched, nondiabetic, pregnant controls, continuous subcutaneous insulin infusions (CSII) were found to mimic more closely than multiple daily injections (given as a premeal bolus) the normal postprandial glucose excursion pattern.

The CSII approach also was associated with fetal fat mass growth patterns similar to those seen in normal pregnancies, said Dr. Mello of the University of Florence, Italy.

The postprandial glucose excursions were calculated as areas under the curves at 0–1, 1–2, 2–4, and 0–4 hours in the three-meal postprandial area. Patients in both treatment groups had similar average daily glucose levels throughout gestation. But at 16−, 26−, and 36-week evaluations, those in the CSII group had 24-hour glycemic profiles similar to the normal group; those in the multiple daily injections group had a significantly longer time period in the three-meal postprandial areas.

Furthermore, fetuses in the CSII group, but not in the multiple daily injection group, had growth patterns similar to those of controls, as measured by ultrasound scans performed every 2 weeks between 25 and 38 weeks' gestation. Those in the multiple daily injections group had significantly higher abdominal and midthigh fat deposition during that period, Dr. Mello noted.

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