Paper
Friday, July 23, 2004
10:00 AM - 10:30 AM
Friday, July 23, 2004
3:00 PM - 3:30 PM
A Study in Patient Outcomes: The Application of an Insulin Analogue in Pregnancy
Loretta Hothersall, MSN, RNC, CS, FNP-C, Maine Center for Diabetes, Maine Center for Diabetes, Maine Center for Endocrinology and Diabetes, Scarborough, ME, USA
Introduction: Glargine insulin has not been approved for use during pregnancy and is considered a Pregnancy Category C. Despite the lack of safety data,clinical determination to continue the use of this insulin was necessary to eliminate recurrent hypoglycemia and the repeated need for glucagon injections with resultant elevations in serum ketone levels and deleterious maternal and fetal outcomes. Objective:To decrease the frequency and severity of hypoglycemic events. To have no greater rate of neonatal complications. Design: Quantitative. Sample: A sample of convenience,(~14)women whose pregnancies were complicated by type 1 or type 2 diabetes and followed at a Diabetes Center in Scarborough, Maine. Methods: Women were divided into 2 groups: (Group 1) women who were well controlled on Glargine prior to conception and wished to remain on this regimen during pregnancy. (Group2) women who were converted from a conventional regimen of insulin to Glargine due to frequent episodes of hypoglycemia and or control issues.During antepartum, maternal and fetal testing was carried out according to protocol as well as maternal glycemic control based on HbA1c,complications and BMI. Maternal delivery and neonatal evaluations were gathered postpartum via chart reviews. Analysis: Analysis of variance was applied to test for differences between the groups in the following outcome variables: glycemic control, frequency of hypoglycemia, and fetal outcomes. Conclusion: Due to the limitations of this study, further study is needed to define the efficacy and safety of Glargine use during pregnancy. The use of Glargine eliminated nocturnal hypoglycemia secondary to stringent glycemic target ranges and decreased the rate of poor neonatal outcomes. Implications: The result of this study will promote a stratergy for the treatment of women with diabetes while improving the quality of patient care.
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Sigma Theta Tau International
July 22-24, 2004