Survey of glargine use in 115 pregnant women with Type 1 diabetes

Gallen, Ian W.; Jaap, Alan J.; Roland, J. M.; Chirayath, Haiju H.

doi:10.1111/j.1464-5491.2007.02339.x

Cited by 60 publications

(30 citation statements)

References 19 publications

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“…70 Several small studies and a meta-analysis have investigated both neonatal and maternal outcomes following glargine use in pregnancy. [71][72][73][74] All have reported no increased fetal or maternal adverse events when glycemic control was obtained using glargine compared with NPH insulin.…”

Section: Pregnancymentioning

confidence: 95%

Basal Insulin Treatment in Type 2 Diabetes

Hedrington

Pulliam

2011

Diabetes Technology & Therapeutics

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Insulin glargine is the first 24-h recombinant DNA insulin analog introduced to the market. Substitution of glycine for asparagine and addition of two arginine residues raise the isoelectric point of insulin glargine and result in microprecipitates, delaying absorption from subcutaneous tissue. This delayed absorption result in fairly flat 24-h insulin concentration profiles with no discernible peak. Large, multicenter, randomized, controlled trials in patients with type 2 diabetes show that although NPH insulin and insulin glargine are equally effective in lowering glycosylated hemoglobin (A1c) and fasting blood glucose, there is a clear advantage of insulin glargine over NPH insulin in reducing nocturnal and overall hypoglycemia. Lower risk of hypoglycemia with glargine was also consistently demonstrated by trials comparing insulin glargine and premixed analog insulins. These studies also showed greater reduction in A1c with twice-daily premixed insulins compared with glargine, when insulin glargine was administered without mealtime insulin coverage. Insulin glargine was also compared with another insulin analog, insulin detemir. Trials showed that both insulin analogs are equally effective in lowering A1c and have comparable risk of hypoglycemia. Trials comparing insulin glargine with glucagon-like peptide-1 agonists showed comparable significant reductions in A1c with both regimens. Insulin glargine is well tolerated, has low immunogenicity, reduced risks for acute myocardial infarction, and a lower risk of hypoglycemia compared with NPH insulin in individuals with type 2 diabetes.

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Section: Pregnancymentioning

confidence: 95%

Basal Insulin Treatment in Type 2 Diabetes

Hedrington

Pulliam

2011

Diabetes Technology & Therapeutics

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“…No large randomized clinical trials with insulin glargine used during pregnancy have been done up to now (21). It was also proven that insulin glargine does not cross the placenta (39), and many studies with small number of patients have shown the safety and efficacy of its use in pregnancy (40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)56). Negrato and cols.…”

Section: Insulin Glarginementioning

confidence: 99%

Insulin analogues in the treatment of diabetes in pregnancy

Negrato¹,

Montenegro

Kostrisch

et al. 2012

Arq Bras Endocrinol Metab

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SUMMARYPregnancy affects both maternal and fetal metabolism, and even in non-diabetic women, it exerts a diabetogenic effect. Among pregnant women, 2% to 14% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, which may predispose the fetus to many alterations in organogenesis, restrict growth, and the mother, to some diabetes-related complications, such as retinopathy and nephropathy, or to acceleration of the course of these complications, if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle changes; when these changes are not enough for optimal glycemic control, insulin therapy must then be considered. Women with type 2 diabetes using oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes should start intensive glycemic control. As basal insulin analogues have frequently been used off-label in pregnant women, there is a need to evaluate their safety and efficacy. The aim of this review is to report the use of both short-and long-acting insulin analogues during pregnancy and to enable clinicians, obstetricians, and endocrinologists to choose the best insulin treatment for their patients. Arq Bras Endocrinol Metab. 2012;56(7):405-14 Keywords Type 1 diabetes; type 2 diabetes; gestational diabetes; insulin analogues; insulin lispro; insulin aspart; insulin glulisine; insulin glargine; insulin detemir SUMÁRIO A gravidez afeta tanto o metabolismo materno quanto o fetal e, mesmo em mulheres não diabéticas, apresenta um efeito diabetogênico. Entre as mulheres grávidas, 2% a 14% desenvolvem o diabetes gestacional. A gravidez pode ocorrer também em mulheres já diabéticas, o que pode predispor o feto a muitas alterações na organogênese, restrição de crescimento e a mãe a algumas complicações relacionadas ao diabetes, tais como retinopatia e nefropatia, ou acelerar o curso dessas complicações se já estiverem presentes. Pacientes com diabetes gestacional geralmente iniciam seu tratamento com dieta e mudanças no estilo de vida; porém, quando essas medidas falham em atingir um controle glicêmico adequado, a insulinoterapia deve ser considerada. Pacientes com diabetes tipo 2 em uso de hipoglicemiantes orais são aconselhadas a iniciar o uso de insulina. Pacientes com diabetes tipo 1 preexistente devem iniciar um controle glicêmico estrito. Em função do fato de os análogos basais de insulina estarem sendo utilizados muito frequentemente off-label em pacientes grávidas, faz-se necessário avaliar sua segurança e eficácia nessa condição. O objetivo desta revisão é avaliar o uso de tais análogos, tanto de ação curta como prolongada, durante a gravidez, para possibilitar médicos clínicos, obstetras e endocrinologistas escolher o melhor regime terapêutico para suas pacientes. Arq Bras Endocrinol Metab. 2012;56(7):405-14 Descritores Diabetes tipo 1; diabetes tipo 2; diabetes

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“…Severe maternal hypoglycemia, defined as requiring third-party assistance, was reported in 22%. In terms of neonatal outcomes, 47% (50/114) of neonates experienced hypoglycemia, mean birth weight was 3500±600g, and three had congenital abnormalities [43].…”

Section: Long Acting Insulin Analoguesmentioning

confidence: 99%

“…In 2008, Gallen et al [43] published an uncontrolled prospective audit of 115 pregnant women with T1DM treated with glargine. Of these, 69% were treated with glargine during the preconception period.…”

Section: Long Acting Insulin Analoguesmentioning

confidence: 99%