Insulin lispro therapy in pregnancies complicated by type 1 diabetes mellitus

Systematic Literature Review of Basal Bolus Insulin Analogue Therapy during Pregnancy

“…Only one congenital malformation with regular insulin was reported. Although there was an associated increase in rate of maternal biochemical hypoglycemic events (<54 mg/dL) in those treated with insulin lispro (5.5 vs. 3.9%, p<0.05), only the regular insulin group experienced severe hypoglycemia episodes [27].…”

“…Persson et al [27] reported one congenital malformation with human insulin, but since randomization did not occur until 14 weeks gestation, this finding should not be attributable to treatments used in the study [27]. Also, Aydin et al [25] demonstrated congenital anomalies in 9 infants born to women who were treated with regular insulin versus none in the lispro group, although differences were not significant [25].…”

“…Similarly, Buchbinder et al [21] showed no change in retinopathy status in patients using lispro, but demonstrated change in 6 patients using regular insulin (extensive proliferative retinopathy developed in one patient, mild background retinopathy developed in in 3 patients, progression of retinopathy occurred in 2 patients) [21]. Persson et al [27] showed development of proliferative retinopathy in one patient in regular insulin group and similar development of mild to moderate background retinopathy in both groups [27].…”

“…GarciaDominguez et al [30] were able to demonstrate significantly lower rates of maternal hypoglycemia in lispro group versus regular insulin [30]. Interestingly, Persson et al [27] showed a significant increase biochemical hypoglycemia (<54 mg/dL) in the lispro group, although no episodes of severe hypoglycemia were demonstrated [27]. The studies observed postprandial glycemia consistently decreased, particularly 1-hour postprandially [12,20,27,31].…”

“…In 2002, randomized controlled trial conducted by Persson et al [27] randomized 16 women to lispro and 17 to regular insulin at 14 weeks' gestational age. Postprandial breakfast glycemic control significantly improved in the lispro compared to regular insulin group (p<0.01).…”