Objective: To determine whether women with pre-existing and gestational diabetes have better medication adherence and pregnancy outcomes when treated with long acting, compared to intermediate acting, insulin.
Methods: We performed a retrospective cohort study of all pregnancies complicated by pregestational and gestational DM from 2007-2017 at a Resident Diabetes in Pregnancy clinic at an academic tertiary care center. Patients were excluded if they did not take long acting or intermediate insulin or took an oral agent in addition, had end stage organ damage, multiple gestation, or fetal anomalies. The primary outcome was maternal medication adherence per physician report. The secondary outcome was a composite neonatal outcome including macrosomia, NICU admission, LGA, shoulder dystocia, individual components of the composite, and glycemic control. Demographic characteristics were compared between groups and logistic regression was used to adjust for potential confounders, including advanced maternal age, weight, race, body mass index, and substance abuse.
Results: Of 926 patients seen during the study period, 808 women met study criteria, by diabetes type: type 1 (n=48), type 2 (n=293) and GDM (n=467). Demographic characteristics were similar between those who used long-acting vs. intermediate insulin. Adjusted analysis using logistic regression demonstrated no significant difference in medication adherence between groups. There was also no difference in the neonatal composite outcome, components of the composite, or glycemic control. Results were similar in stratified analysis by diabetes type.
Conclusion: Medication adherence was similar between women using long and intermediate acting insulin and there was no change in neonatal outcomes. Our findings call into question the notion that the twice daily dosing of intermediate insulin in pregnancy provides tighter glycemic control, although medication adherence did not suffer.
S.A. Nazeer: None. C.J. Herrick: None. H.E. Duckham: None. E.B. Carter: None.
American Diabetes Association/Pathway to Stop Diabetes (1-19-ACE-02 to E.B.C.)